A Prospective Registry of Atrial Fibrillation Ablation with the Ablation Index Technology: Rationale and Study Design

Cardiology ◽  
2020 ◽  
Vol 145 (11) ◽  
pp. 730-735 ◽  
Author(s):  
Nigar Z. Gasimova ◽  
Grigory V. Kolunin ◽  
Elena A. Artyukhina ◽  
Eduard A. Ivanitsky ◽  
Dmitry S. Lebedev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Ablation Lesion ◽  
Safety And Efficacy ◽  
Lesion Depth ◽  
Af Ablation ◽  
Ablation Index ◽  
Personal Skills ◽  
Multicenter Registry

This is a prospective multicenter registry of atrial fibrillation (AF) ablation with the Ablation Index (AI) technology, which has been introduced as a marker predicting ablation lesion depth. The index incorporates the main parameters of radiofrequency point-by-point ablation: power, contact force, and time of ablation. The AI is calculated for every operator depending on personal skills, and there are no strict indications on the range of the parameter considering its safety and efficacy during pulmonary vein isolation. The registry aims to evaluate AI values used in different centers by different operators and to evaluate the optimal limits associated with better acute and long-term AF ablation results.

scholarly journals Ablation of Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy: Treatment Strategy, Characteristics of Consecutive Atrial Tachycardia and Long‐Term Outcome

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Leon Dinshaw ◽  
Paula Münkler ◽  
Benjamin Schäffer ◽  
Niklas Klatt ◽  
Christiane Jungen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Drug Therapy ◽  
Hypertrophic Cardiomyopathy ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Antiarrhythmic Drug Therapy ◽  
Af Ablation

Background Atrial fibrillation (AF) is common in patients with hypertrophic cardiomyopathy (HCM) and is associated with a deterioration of clinical status. Ablation of symptomatic AF is an established therapy, but in HCM, the characteristics of recurrent atrial arrhythmias and the long‐term outcome are uncertain. Methods and Results Sixty‐five patients with HCM (aged 64.5±9.9 years, 42 [64.6%] men) underwent AF ablation. The ablation strategy included pulmonary vein isolation in all patients and ablation of complex fractionated atrial electrograms or subsequent atrial tachycardias (AT) if appropriate. Paroxysmal, persistent AF, and a primary AT was present in 13 (20.0%), 51 (78.5%), and 1 (1.5%) patients, respectively. Twenty‐five (38.4%) patients developed AT with a total number of 54 ATs. Stable AT was observed in 15 (23.1%) and unstable AT in 10 (15.3%) patients. The mechanism was characterized as a macroreentry in 37 (68.5%), as a localized reentry in 12 (22.2%), a focal mechanism in 1 (1.9%), and not classified in 4 (7.4%) ATs. After 1.9±1.2 ablation procedures and a follow‐up of 48.1±32.5 months, freedom of AF/AT recurrences was demonstrated in 60.0% of patients. No recurrences occurred in 84.6% and 52.9% of patients with paroxysmal and persistent AF, respectively ( P <0.01). Antiarrhythmic drug therapy was maintained in 24 (36.9%) patients. Conclusions AF ablation in patients with HCM is effective for long‐term rhythm control, and especially patients with paroxysmal AF undergoing pulmonary vein isolation have a good clinical outcome. ATs after AF ablation are frequently observed in HCM. Freedom of atrial arrhythmia is achieved by persistent AF ablation in a reasonable number of patients even though the use of antiarrhythmic drug therapy remains high.

scholarly journals The industrialization of ablation: a highly standardized and reproducible workflow for radiofrequency ablation of atrial fibrillation

2019 ◽  
Vol 59 (1) ◽  
pp. 21-27
Author(s):  
Tom De Potter ◽  
Tina D. Hunter ◽  
Lee Ming Boo ◽  
Sofia Chatzikyriakou ◽  
Teresa Strisciuglio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
High Volume ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Atrial Arrhythmia ◽  
Af Ablation ◽  
Ablation Index ◽  
Effectiveness Endpoint

Abstract Background or Purpose The purpose of this analysis was to report on efficacy of a standardized workflow for atrial fibrillation (AF) ablation using technology advances such as 3D imaging and contact force sensing in a real-world setting. Methods Consecutive AF ablations from 2014 to 2015 at a high-volume site in Belgium were included. The workflow consisted of a pre-specified procedure sequence including 3D modeling followed by radiofrequency encircling of the pulmonary veins (25 W posterior wall, 35 W anterior wall) with a THERMOCOOL SMARTTOUCH® Catheter guided by CARTO VISITAG™ Module (2.5 mm/5 s stability, 50% > 7 g) and ablation index (targets: 550 anterior wall, 400 posterior wall). Efficiency endpoints were procedure time, fluoroscopy time, and radiation dose. The primary effectiveness endpoint was freedom from atrial arrhythmia recurrence. Results A total of 605 paroxysmal AF (PAF) and 182 persistent AF (PsAF) patients were followed for 436 ± 199 days. Mean procedure times were short (PAF: 96.1 ± 26.2 min; PsAF: 109.2 ± 35.6 min) with most procedures (90.6% PAF; 81.3% PsAF) completed in ≤ 120 min. Minimal fluoroscopy was utilized (PAF: 6.1 ± 3.8 min, 5.9 ± 3.4 Gy*cm2; PsAF: 6.9 ± 4.7 min, 7.4 ± 4.9 Gy*cm2). Freedom from atrial arrhythmia recurrence was higher for PAF than PsAF patients (OR: 2.0, 95% CI: 1.4–2.9, p = 0.0003), but adjusted mean rates were high in both groups (81.0% vs. 67.9%). Rates were adjusted for prior ablation and age (at 65 years). Conclusion AF ablation using a standardized workflow resulted in low procedure times and variability, with minimal fluoroscopy exposure. Long-term freedom from atrial arrhythmia recurrence was high in both PAF and PsAF populations.

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 &lt; 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 &lt; 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 &lt; 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 Safety and Efficacy of High Power Shorter Duration Ablation Guided by Ablation Index or Lesion Size Index in Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Xing Liu ◽  
Chun Gui ◽  
Weiming Wen ◽  
Yan He ◽  
Weiran Dai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
High Power ◽  
Lesion Size ◽  
Fluoroscopy Time ◽  
Safety And Efficacy ◽  
Ablation Index ◽  
Size Index ◽  
First Pass ◽  
Esophageal Lesion

Background. High power shorter duration (HPSD) ablation may lead to safe and rapid lesion formation. However, the optimal radio frequency power to achieve the desired ablation index (AI) or lesion size index (LSI) is insubstantial. This analysis aimed to appraise the clinical safety and efficacy of HPSD guided by AI or LSI (HPSD-AI or LSI) in patients with atrial fibrillation (AF). Methods. The Medline, PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing HPSD-AI or LSI and low power longer duration (LPLD) ablation. Results. Seven trials with 1013 patients were included in the analysis. The analyses verified that HPSD-AI or LSI revealed benefits of first-pass pulmonary vein isolation (PVI) (RR: 1.28; 95% CI: 1.05–1.56, P = 0.01) and acute pulmonary vein reconnection (PVR) (RR: 0.65; 95% CI: 0.48–0.88, P = 0.005) compared with LPLD. HPSD-AI or LSI showed higher freedom from atrial tachyarrhythmia (AT) (RR = 1.32, 95% CI: 1.14–1.53, P = 0.0002) in the subgroup analysis of studies with PVI ± (with or without additional ablation beyond PVI). HPSD-AI or LSI could short procedural time (WMD: −22.81; 95% CI, −35.03 to −10.60, P = 0.0003), ablation time (WMD: −10.80; 95% CI: −13.14 to −8.46, P < .00001), and fluoroscopy time (WMD: −7.71; 95% CI: −13.71 to −1.71, P = 0.01). Major complications and esophageal lesion in HPSD-AI or LSI group were no more than LDLP group (RR: 0.58; 95% CI: 0.20–1.69, P = 0.32) and (RR: 0.84; 95% CI: 0.43–1.61, P = 0.59). Conclusions. HPSD-AI or LSI was efficient for treating AF with shorting procedural, ablation, and fluoroscopy time, higher first-pass PVI, and reducing acute PVR and may increase freedom from AT for patients with additional ablation beyond PVI compared with LPLD. Moreover, complications and esophageal lesion were low and no different between two groups.

Abstract 17041: Outcomes After Atrial Fibrillation Ablation With and Without CTI Ablation: Insights From the UC San Diego AF Ablation Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Praneet S Mylavarapu ◽  
Omar M Aldaas ◽  
Chaitanya Malladi ◽  
Florentino Lupercio ◽  
Frederick Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
San Diego ◽  
Atrial Arrhythmias ◽  
Af Ablation ◽  
Procedural Complications ◽  
First Time

Introduction: Pulmonary vein isolation (PVI) is a well-established therapy for patients with drug refractory atrial fibrillation (AF). However, it remains unclear whether prophylactic cavotricuspid isthmus (CTI) ablation at the time of PVI improves long-term freedom from AF. Several studies have examined short term outcomes, but none beyond several years post procedure. Methods: We performed a retrospective study of all patients who underwent first-time radiofrequency catheter ablation enrolled in the UC San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off anti-arrhythmic drugs (AAD). Results: Of 534 total patients, 63 (11.8%) underwent pulmonary vein isolation (PVI) without CTI ablation, 471 (88.2%) underwent PVI with CTI ablation. Median follow-up duration was 3.9 (0.4 - 6.8) years. CTI ablation did not improve freedom from atrial arrhythmias in those with either paroxysmal AF [Adjusted Hazard Ratio (AHR) 1.15 (95% CI 0.59-2.24) for CTI vs non-CTI ablation] or persistent AF [AHR 0.82 (95% CI 0.38-1.77) for CTI vs non-CTI ablation]. Among all patients, there were also no differences in procedural complications [AHR 1.09 (95% CI 0.33-3.62) for CTI vs. non-CTI ablation] or all-cause mortality [AHR 1.12 (95% CI 0.57-2.23) for CTI vs. non-CTI ablation]. Conclusion: In this registry analysis, prophylactic CTI ablation at the time of first PVI did not improve freedom from recurrent atrial arrhythmias at 5 years among those with paroxysmal or persistent AF as compared to PVI alone.

Real-time local impedance monitoring to assess tissue lesion during pulmonary vein isolation: a new tool for AF ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Di Cori ◽  
L Segreti ◽  
G Zucchelli ◽  
S Viani ◽  
F Tarasco ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Vascular Complications ◽  
Lesion Formation ◽  
Tissue Impedance ◽  
Af Ablation ◽  
Group 2 ◽  
Group 1

Abstract Background Contact force catheter ablation is the gold standard for treatment of atrial fibrillation (AF). Local tissue impedance (LI) evaluation has been recently studied to evaluate lesion formation during radiofrequency ablation. Purpose Aim of the study was to assess the outcomes of an irrigated catether with LI alghorithm compared to contact force (CF)-sensing catheters in the treatment of symptomatic AF. Methods A prospective, single-center, nonrandomized study was conducted, to compare outcomes between CF-AF ablation (Group 1) and LI-AF ablation (Group 2). For Group 1 ablation was performed using the Carto 3© System with the SmartTouch SF catheter and, as ablation target, an ablation index value of 500 anterior and 400 posterior. For Group 2, ablation was performed using the Rhythmia™ System with novel ablation catheter with a dedicated algorithm (DirectSense) used to measure LI at the distal electrode of this catheter. An absolute impedance drop greater than 20Ω was used at each targeted. According to the Close Protocol, ablation included a point by point pulmonary vein isolation (PVI) with an Inter-lesion space ≤5 mm in both Groups. Procedural endpoint was PVI, with confirmed bidirectional block. Results A total of 116 patients were enrolled, 59 patients in Group 1 (CF) and 57 in Group 2 (LI), 65 (63%) with a paroxismal AF and 36 (37%) with a persistent AF. Baseline patients features were not different between groups (P=ns). LI-Group showed a comparable procedural time (180±89 vs 180±56, P=0.59) but with a longer fluoroscopy time (20±12 vs 13±9 min, P=0.002). Wide antral isolation was more often observed in CF-Group (95% vs 80%, P=0.022), while LI-Group 2 required frequently additional right or left carina ablation (28% vs 14%, P=0.013). The mean LI was 106±14Ω prior to ablation and 92.5±11Ω after ablation (mean LI drop of 13.5±8Ω) during a median RF time of 26 [19–34] sec for each ablation spot. No steam pops or complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated in all study patients. Regarding safety, only minor vascular complications were observed (5%), without differences between groups (p=0.97). During follow up, 9-month freedom from atrial fibrillation/atrial flutter/atrial tachycardia recurrence was 86% in Group 1 and 75% in Group 2 (P=0.2). Conclusions An LI-guided PV ablation strategy seems to be safe and effective, with acute and mid-term outcomes comparable to the current contact force strategy. LI monitoring could be a promising complementary parameter to evaluate not only wall contact but also lesion formation during power delivery. Procedural Outcomes Funding Acknowledgement Type of funding source: None

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