INTRODUCTION: Pulmonary vein isolation (PVI) using contact force (CF) sensing ablation catheters currently relies on CF and force-time integral (FTI) guidelines. Such measurement of lesion effectiveness still lacks information on current delivery to the tissue, influenced by system impedance and power. Lesion Index (LSI) is a multi-parametric index incorporating CF and radiofrequency current data across time. We aimed to prospectively assess the efficacy of an LSI-guided approach to PVI in patients with paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: The study prospectively enrolled 28 consecutive patients with PAF undergoing PVI with a CF sensing catheter (TactiCathTM, Abbott). LSI-guided ablation target was adapted according to the mean regional thickness of pulmonary vein antra (PVA): LSI range 5.5-6 was pursued in the anterior and septal portions of PVA, 5-5.5 elsewhere. Data from 32 consecutive PAF patients who underwent PVI ablation with a non-CF guided approach (NCF-group) were retrospectively collected for comparison of procedural and clinical outcome.AF-free survival rate at follow-up (17±6 months) was higher for LSI-guided group than NCF-group (89.3% vs 65.6%, p=0.037), with no increase in periprocedural complication rate (no tamponades or other major adverse events reported). Among 1126 lesions with LSI within target range (5-6), average CF was >10g and <30g for 976 lesions (86.7%). Moreover, 1015 lesions (90.1%) had FTI>400gs, but with wide distribution: 30.2% within 400-500gs, 30.0% within 501-600gs, 29.9% over 600gs. CONCLUSION: In this first prospective study, LSI-guided PVI improved clinical outcome without any increase in complication rate when compared with standard, non-LSI-guided approach.
INTRODUCTION: Pulmonary vein isolation (PVI) using contact force (CF) sensing ablation catheters currently relies on CF and force-time integral (FTI) guidelines. Such measurement of lesion effectiveness still lacks information on current delivery to the tissue, influenced by system impedance and power. Lesion Index (LSI) is a multi-parametric index incorporating CF and radiofrequency current data across time. We aimed to prospectively assess the efficacy of an LSI-guided approach to PVI in patients with paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: The study prospectively enrolled 28 consecutive patients with PAF undergoing PVI with a CF sensing catheter (TactiCathTM, Abbott). LSI-guided ablation target was adapted according to the mean regional thickness of pulmonary vein antra (PVA): LSI range 5.5-6 was pursued in the anterior and septal portions of PVA, 5-5.5 elsewhere. Data from 32 consecutive PAF patients who underwent PVI ablation with a non-CF guided approach (NCF-group) were retrospectively collected for comparison of procedural and clinical outcome.AF-free survival rate at follow-up (17±6 months) was higher for LSI-guided group than NCF-group (89.3% vs 65.6%, p=0.037), with no increase in periprocedural complication rate (no tamponades or other major adverse events reported). Among 1126 lesions with LSI within target range (5-6), average CF was >10g and <30g for 976 lesions (86.7%). Moreover, 1015 lesions (90.1%) had FTI>400gs, but with wide distribution: 30.2% within 400-500gs, 30.0% within 501-600gs, 29.9% over 600gs. CONCLUSION: In this first prospective study, LSI-guided PVI improved clinical outcome without any increase in complication rate when compared with standard, non-LSI-guided approach.
Authors: Dipen C Shah; Hendrik Lambert; Hiroshi Nakagawa; Arne Langenkamp; Nicolas Aeby; Giovanni Leo Journal: J Cardiovasc Electrophysiol Date: 2010-09
Authors: Andrea Natale; Vivek Y Reddy; George Monir; David J Wilber; Bruce D Lindsay; H Thomas McElderry; Charan Kantipudi; Moussa C Mansour; Daniel P Melby; Douglas L Packer; Hiroshi Nakagawa; Baohui Zhang; Robert B Stagg; Lee Ming Boo; Francis E Marchlinski Journal: J Am Coll Cardiol Date: 2014-08-19 Impact factor: 24.094
Authors: Vivek Y Reddy; Dipen Shah; Josef Kautzner; Boris Schmidt; Nadir Saoudi; Claudia Herrera; Pierre Jaïs; Gerhard Hindricks; Petr Peichl; Aude Yulzari; Hendrik Lambert; Petr Neuzil; Andrea Natale; Karl-Heinz Kuck Journal: Heart Rhythm Date: 2012-07-20 Impact factor: 6.343
Authors: Aravinda Thiagalingam; Andre D'Avila; Lori Foley; J Luis Guerrero; Hendrik Lambert; Giovanni Leo; Jeremy N Ruskin; Vivek Y Reddy Journal: J Cardiovasc Electrophysiol Date: 2010-02-01
Authors: Atul Verma; Fethi Kilicaslan; Ennio Pisano; Nassir F Marrouche; Raffaele Fanelli; Johannes Brachmann; Jens Geunther; Domenico Potenza; David O Martin; Jennifer Cummings; J David Burkhardt; Walid Saliba; Robert A Schweikert; Andrea Natale Journal: Circulation Date: 2005-08-02 Impact factor: 29.690
Authors: Vivek Y Reddy; Srinivas R Dukkipati; Petr Neuzil; Andrea Natale; Jean-Paul Albenque; Josef Kautzner; Dipen Shah; Gregory Michaud; Marcus Wharton; David Harari; Srijoy Mahapatra; Hendrik Lambert; Moussa Mansour Journal: Circulation Date: 2015-08-10 Impact factor: 29.690