Francesco Santoro1,2, Andreas Metzner3, Natale Daniele Brunetti4, Christian-H Heeger3,5, Shibu Mathew3, Bruno Reissmann3, Christine Lemeš3, Tilman Maurer3, Thomas Fink3, Laura Rottner3, Osamu Inaba3, Karl-Heinz Kuck3, Feifan Ouyang3, Andreas Rillig3,6. 1. Department of Cardiology, Asklepios Klinik - St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany. dr.francesco.santoro.it@gmail.com. 2. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. dr.francesco.santoro.it@gmail.com. 3. Department of Cardiology, Asklepios Klinik - St Georg, Lohmühlenstraße 5, 20099, Hamburg, Germany. 4. Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy. 5. University Heart Center Lübeck, Lübeck, Germany. 6. Department of Cardiology of the University of Berlin Campus Benjamin Franklin, Charité, Herzmedizin Berlin, Franklin, Germany.
Abstract
BACKGROUND: Ablation index (AI) is a novel ablation quality marker that incorporates contact force (CF), time and power in a weighted formula to provide accurate information about lesion formation during catheter ablation. This index has been evaluated for pulmonary vein isolation (PVI) but has not been systematically used for other left atrial (LA) procedures so far. The aim of this study is to evaluate the feasibility and efficacy of this index for LA anterior line (AL) ablation (LAALA). METHODS: 30 consecutive patients with persistent atrial fibrillation or LA macro-reentrant tachycardia and large low-voltage area at the left atrial anterior wall were evaluated and divided into 2 groups: group 1 (15 pts) LAALA guided by CF; group 2 (15 pts) LAALA guided by AI target (500) and inter-lesion distance ≤ 6 mm. RESULTS: In group 2, shorter ablation time (12.5 ± 3.8 vs 17 ± 7 min, p = 0.049), overall RF application time (7.9 ± 1.4 vs 10.8 ± 3.2 min. p = 0.01) and less radiofrequency (RF) applications (14.5 ± 2.3 vs 20.5 ± 6.1 p = 0.01) were necessary to achieve AL bi-directional block. Acute reconnection of the AL was documented in three patients (20%) of group 1 and in no patient of group 2 (20% vs 0% p = 0.22). At site of reconnection, an inter-lesion distance > 6 mm was always found. There was no difference in terms of CF and power between group 2 and group 1. AI was statistically different between group 2 and group 1 (AI = 511 ± 77 vs 451 ± 111; p = 0.004). CONCLUSION: AI-guided LAALA in this study was feasible and featured by shorter ablation time, shorter overall RF application time and a reduced number of RF applications to achieve AL bidirectional block.
BACKGROUND: Ablation index (AI) is a novel ablation quality marker that incorporates contact force (CF), time and power in a weighted formula to provide accurate information about lesion formation during catheter ablation. This index has been evaluated for pulmonary vein isolation (PVI) but has not been systematically used for other left atrial (LA) procedures so far. The aim of this study is to evaluate the feasibility and efficacy of this index for LA anterior line (AL) ablation (LAALA). METHODS: 30 consecutive patients with persistent atrial fibrillation or LA macro-reentrant tachycardia and large low-voltage area at the left atrial anterior wall were evaluated and divided into 2 groups: group 1 (15 pts) LAALA guided by CF; group 2 (15 pts) LAALA guided by AI target (500) and inter-lesion distance ≤ 6 mm. RESULTS: In group 2, shorter ablation time (12.5 ± 3.8 vs 17 ± 7 min, p = 0.049), overall RF application time (7.9 ± 1.4 vs 10.8 ± 3.2 min. p = 0.01) and less radiofrequency (RF) applications (14.5 ± 2.3 vs 20.5 ± 6.1 p = 0.01) were necessary to achieve AL bi-directional block. Acute reconnection of the AL was documented in three patients (20%) of group 1 and in no patient of group 2 (20% vs 0% p = 0.22). At site of reconnection, an inter-lesion distance > 6 mm was always found. There was no difference in terms of CF and power between group 2 and group 1. AI was statistically different between group 2 and group 1 (AI = 511 ± 77 vs 451 ± 111; p = 0.004). CONCLUSION: AI-guided LAALA in this study was feasible and featured by shorter ablation time, shorter overall RF application time and a reduced number of RF applications to achieve AL bidirectional block.
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