Milad El Haddad1, Philippe Taghji1, Thomas Phlips1, Michael Wolf1, Anthony Demolder1, Rajin Choudhury1, Sébastien Knecht1, Yves Vandekerckhove1, Rene Tavernier1, Hiroshi Nakagawa1, Mattias Duytschaever2. 1. From the Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (M.E.H., P.T., T.P., M.W., R.C., S.K., Y.V., R.T., M.D.); Department of Internal Medicine, Ghent University, Belgium (M.E.H., A.D., M.D.); and Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center (H.N.). 2. From the Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (M.E.H., P.T., T.P., M.W., R.C., S.K., Y.V., R.T., M.D.); Department of Internal Medicine, Ghent University, Belgium (M.E.H., A.D., M.D.); and Heart Rhythm Institute and Department of Medicine, University of Oklahoma Health Sciences Center (H.N.). mattias.duytschaever@azsintjan.be.
Abstract
BACKGROUND: Pulmonary vein reconnection (PVR) still determines recurrences of atrial fibrillation after contact force (CF)-guided pulmonary vein isolation. We studied whether acute PVR (adenosine and waiting time) and late PVR (at repeat) are explained by incomplete transmurality and contiguity within the deployed radiofrequency circle. METHODS AND RESULTS: We analyzed 42 CF-guided ipsilateral pulmonary vein isolation procedures. For each radiofrequency tag within the circle, we collected data reflecting lesion depth (time of application, power, impedance drop [Δ-Imp], CF, force-time integral [FTI], and ablation index [AI]) and contiguity (automated interlesion distance [ILD]). Ablation line contiguity index (ALCI) was developed as a novel automated algorithm combining depth and contiguity into one single criterion. Each circle was subdivided into 10 segments. For each segment, we determined its weakest link by annotating timemin, powermin, Δ-Impmin, CFmin, FTImin, AImin, ILDmax, and ALCImin. Compared with segments without PVR (n=758), PVR segments (n=44) were characterized by lower Δ-Impmin (4.8 versus 7.4 Ω), CFmin (8.5 versus 11.8 g), FTImin (351 versus 473 gs), AImin (367 versus 408 arbitrary unit [au]), and higher ILDmax (6.8 versus 5.5 mm). ALCImin was significantly lower in segments with PVR (74% versus 104%; P<0.001) and was associated with the highest accuracy to predict durable segments (area under the curve=0.73). CONCLUSIONS: In CF-guided pulmonary vein isolation, PVR is explained by lack of both lesion depth and contiguity within the deployed radiofrequency circle. ALCI, a novel measure combing contiguity and depth, is the most accurate predictor for durable segments. By avoiding weak links in the ablation chain, ALCI-guided ablation is expected to improve success rate of point-by-point radiofrequency ablation.
BACKGROUND: Pulmonary vein reconnection (PVR) still determines recurrences of atrial fibrillation after contact force (CF)-guided pulmonary vein isolation. We studied whether acute PVR (adenosine and waiting time) and late PVR (at repeat) are explained by incomplete transmurality and contiguity within the deployed radiofrequency circle. METHODS AND RESULTS: We analyzed 42 CF-guided ipsilateral pulmonary vein isolation procedures. For each radiofrequency tag within the circle, we collected data reflecting lesion depth (time of application, power, impedance drop [Δ-Imp], CF, force-time integral [FTI], and ablation index [AI]) and contiguity (automated interlesion distance [ILD]). Ablation line contiguity index (ALCI) was developed as a novel automated algorithm combining depth and contiguity into one single criterion. Each circle was subdivided into 10 segments. For each segment, we determined its weakest link by annotating timemin, powermin, Δ-Impmin, CFmin, FTImin, AImin, ILDmax, and ALCImin. Compared with segments without PVR (n=758), PVR segments (n=44) were characterized by lower Δ-Impmin (4.8 versus 7.4 Ω), CFmin (8.5 versus 11.8 g), FTImin (351 versus 473 gs), AImin (367 versus 408 arbitrary unit [au]), and higher ILDmax (6.8 versus 5.5 mm). ALCImin was significantly lower in segments with PVR (74% versus 104%; P<0.001) and was associated with the highest accuracy to predict durable segments (area under the curve=0.73). CONCLUSIONS: In CF-guided pulmonary vein isolation, PVR is explained by lack of both lesion depth and contiguity within the deployed radiofrequency circle. ALCI, a novel measure combing contiguity and depth, is the most accurate predictor for durable segments. By avoiding weak links in the ablation chain, ALCI-guided ablation is expected to improve success rate of point-by-point radiofrequency ablation.
Authors: Leon Iden; Sonia Busch; Daniel Steven; Roland R Tilz; Dong-In Shin; K R Julian Chun; Heidi Estner; Felix Bourier; David Duncker; Philipp Sommer; Andreas Metzner; Tilman Maurer; Nils-Christian Ewertsen; Henning Jansen; Andreas Rillig; Victoria Johnson; Till Althoff Journal: Herzschrittmacherther Elektrophysiol Date: 2021-07-26
Authors: J Fedida; T Strisciuglio; M Sohal; M Wolf; K Van Beeumen; A Neyrinck; P Taghji; C Lepiece; A Almorad; Y Vandekerckhove; R Tavernier; M Duytschaever; S Knecht Journal: J Interv Card Electrophysiol Date: 2018-02-24 Impact factor: 1.900
Authors: Tilman Maurer; Laura Rottner; Hisaki Makimoto; Bruno Reissmann; Christian-H Heeger; Christine Lemes; Thomas Fink; Johannes Riedl; Francesco Santoro; Peter Wohlmuth; Marius Volkmer; Shibu Mathew; Andreas Metzner; Feifan Ouyang; Karl-Heinz Kuck; Christian Sohns Journal: Clin Res Cardiol Date: 2018-05-08 Impact factor: 5.460