Giuseppe Stabile1,2,3, Antoine Lepillier4, Ermenegildo De Ruvo5, Marco Scaglione6, Matteo Anselmino7, Frederic Sebag8, Domenico Pecora9, Mark Gallagher10, Mariano Rillo11, Graziana Viola12, Luca Rossi13, Valerio De Santis14, Maurizio Landolina15, Antonello Castro16, Massimo Grimaldi17, Nicolas Badenco18, Maurizio Del Greco19, Antonio De Simone2, Ennio Pisanò20, Salim Abbey21, Filippo Lamberti22, Antonio Pani23, Giulio Zucchelli24, Giuseppe Sgarito25, Daniela Dugo26, Emanuele Bertaglia27, Teresa Strisciuglio1,28, Francesco Solimene1. 1. Clinica Montevergine, Mercogliano, Avellino, Italy. 2. Clinica San Michele, Maddaloni, Caserta, Italy. 3. Anthea Hospital, Bari, Italy. 4. Centre Cardiologique du Nord, St. Denis, Paris, France. 5. Policlinico Casilino, Roma, Italy. 6. Ospedale Cardinal Massaia, Asti, Italy. 7. Department of Medical Sciences, A. O. U. Citta della Salute e della Scienza di Torino, University of Turin, Italy. 8. Institut Mutualiste Montsouris, Paris, France. 9. Fondazione Poliambulanza, Brescia, Italy. 10. St. George's Hospital, London, UK. 11. Casa di Cura Villa Verde, Taranto, Italy. 12. Ospedale San Francesco, Nuoro, Italy. 13. Ospedale Civili Guglielmo da Saliceto, Piacenza, Italy. 14. Istituto Clinico Sant'Ambrogio, Milano, Italy. 15. Ospedale Maggiore di Crema, Italy. 16. Ospedale Pertini, Roma, Italy. 17. Ospedale Regionale Miulli, Acquaviva delle Fonti, Metropolitan City of Bari, Italy. 18. Centre La Pitiè Salpetriere, Paris, France. 19. Ospedale S Maria Del Carmine, Rovereto, Trentino, Italy. 20. Ospedale Vito Fazzi, Lecce, Italy. 21. Hôpital Privé Du Confluent (HPCN), Nantes, France. 22. Ospedale Sant'Eugenio, Roma, Italy. 23. Ospedale di Lecco, Italy. 24. Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. 25. R. N. A.S. Civico Cristina Benfratelli, Palermo, Italy. 26. AUO Policlinico Vittorio Emanuele, Catania, Italy. 27. Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padua, Italy. 28. Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Abstract
BACKGROUND: Ablation index (AI) is a new lesion quality marker that has been demonstrated to allow a high single-procedure arrhythmia-free survival in single-center studies. This prospective, multi-center study was designed to evaluate the reproducibility of pulmonary vein (PV) isolation guided by the AI. METHODS: A total of 490 consecutive patients with paroxysmal (80.4%) and persistent AF underwent first time PV isolation and were divided in four study groups according to operator's preference in choosing the ablation catheter (a contact force (ST) or contact force surround flow (STSF) catheter) and the AI setting (330-450 or 380-500 at anterior wall or posterior wall, respectively). RESULTS: At 12 months a high rate of freedom from AF recurrences was observed in patients with both paroxysmal and persistent AF (91% vs 83.3%; P = .039). There was no difference in the rate of AF recurrence among the four study groups (4.5% in group ST330-450, 12.2% in group ST 380-500, 14.9% in group STSF330-450, 9.4% in group STSF380-500; P = .083). Recurrence was also similar between patients treated with a ST (8%) or STSF catheter (12.1%; P = .2), and within patients targeting an AI settings of 330 to 450 (10.9%) or 380 to 500 (10.3%; P = .64). In patients with paroxysmal AF, there was no difference (P = .12) in the 1-year freedom from AF recurrence among 14 operators that performed ≥10 ablation procedure. CONCLUSIONS: An ablation protocol respecting strict criteria for contiguity and quality lesion resulted in high rate of 1-year freedom from AF recurrence, irrespective of the ablation catheters, AI settings, and operator.
BACKGROUND: Ablation index (AI) is a new lesion quality marker that has been demonstrated to allow a high single-procedure arrhythmia-free survival in single-center studies. This prospective, multi-center study was designed to evaluate the reproducibility of pulmonary vein (PV) isolation guided by the AI. METHODS: A total of 490 consecutive patients with paroxysmal (80.4%) and persistent AF underwent first time PV isolation and were divided in four study groups according to operator's preference in choosing the ablation catheter (a contact force (ST) or contact force surround flow (STSF) catheter) and the AI setting (330-450 or 380-500 at anterior wall or posterior wall, respectively). RESULTS: At 12 months a high rate of freedom from AF recurrences was observed in patients with both paroxysmal and persistent AF (91% vs 83.3%; P = .039). There was no difference in the rate of AF recurrence among the four study groups (4.5% in group ST330-450, 12.2% in group ST 380-500, 14.9% in group STSF330-450, 9.4% in group STSF380-500; P = .083). Recurrence was also similar between patients treated with a ST (8%) or STSF catheter (12.1%; P = .2), and within patients targeting an AI settings of 330 to 450 (10.9%) or 380 to 500 (10.3%; P = .64). In patients with paroxysmal AF, there was no difference (P = .12) in the 1-year freedom from AF recurrence among 14 operators that performed ≥10 ablation procedure. CONCLUSIONS: An ablation protocol respecting strict criteria for contiguity and quality lesion resulted in high rate of 1-year freedom from AF recurrence, irrespective of the ablation catheters, AI settings, and operator.