Alessio Gasperetti1,2, Rita Sicuso1, Antonio Dello Russo3, Giulio Zucchelli4, Ardan Muammer Saguner2, Pasquale Notarstefano5, Ezio Soldati4, Maria Grazia Bongiorni4, Domenico Giovanni Della Rocca6, Sanghamitra Mohanty6, Corrado Carbucicchio1, Firat Duru2, Luigi Di Biase7, Andrea Natale6, Claudio Tondo1,8, Michela Casella1,9. 1. Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milan, IT, Italy. 2. Cardiology Department, Heart Center University Hospital Zürich, Zürich, CH, Switzerland. 3. Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, IT, Italy. 4. Second Division of Cardiovascular Diseases, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, IT, Italy. 5. Cardiovascular and Neurological Department, San Donato Hospital, Arezzo, IT, Italy. 6. Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, TX, USA. 7. Cardiology Department, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Alber Einstein College of Medicine, Bronx, NY, USA. 8. Department of Clinical Sciences and Community Health, University of Milan, Milan, IT, Italy. 9. Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences, University Hospital "Umberto I-Lancisi-Salesi" Marche Polytechnic University, Ancona, Italy.
Abstract
AIMS: Radiofrequency catheter ablation (RFCA) represents an effective option for idiopathic premature ventricular contractions (PVCs) treatment. Ablation Index (AI) is a novel ablation marker incorporating RF power, contact force, and time of delivery into a single weighted formula. Data regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was to compare AI-guided and standard RFCA outcomes in patients with PVCs originating from the right ventricle outflow tract (RVOT). METHODS AND RESULTS: Consecutive patients undergoing AI-guided RFCA of RVOT idiopathic PVCs were prospectively enrolled. Radiofrequency catheter ablation was performed following per-protocol target cut-offs of AI, depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI cut-off: 610). A multi-centre cohort of propensity-matched (age, sex, ejection fraction, and PVC site) patients undergoing standard PVCs RFCA was used as a comparator. Sixty AI-guided patients (44.2 ± 18.0 years old, 58% male, left ventricular ejection fraction 56.2 ± 3.8%) were enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in the RVOT free wall area. Propensity match with 60 non-AI-guided patients was performed. Acute outcomes and complications resulted comparable. At 6 months, arrhythmic recurrence was more common in non-AI-guided patients whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation Index guidance was associated with improved survival from arrhythmic recurrence [overall odds ratio 6.61 (1.95-22.35), P = 0.001; RVOT septum 5.99 (1.21-29.65), P = 0.028; RVOT free wall 11.86 (1.12-124.78), P = 0.039]. CONCLUSION: Ablation Index-guidance in idiopathic PVCs ablation was associated with better arrhythmic outcomes at 6 months of follow-up. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Radiofrequency catheter ablation (RFCA) represents an effective option for idiopathic premature ventricular contractions (PVCs) treatment. Ablation Index (AI) is a novel ablation marker incorporating RF power, contact force, and time of delivery into a single weighted formula. Data regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was to compare AI-guided and standard RFCA outcomes in patients with PVCs originating from the right ventricle outflow tract (RVOT). METHODS AND RESULTS: Consecutive patients undergoing AI-guided RFCA of RVOT idiopathic PVCs were prospectively enrolled. Radiofrequency catheter ablation was performed following per-protocol target cut-offs of AI, depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI cut-off: 610). A multi-centre cohort of propensity-matched (age, sex, ejection fraction, and PVC site) patients undergoing standard PVCs RFCA was used as a comparator. Sixty AI-guided patients (44.2 ± 18.0 years old, 58% male, left ventricular ejection fraction 56.2 ± 3.8%) were enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in the RVOT free wall area. Propensity match with 60 non-AI-guided patients was performed. Acute outcomes and complications resulted comparable. At 6 months, arrhythmic recurrence was more common in non-AI-guided patients whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation Index guidance was associated with improved survival from arrhythmic recurrence [overall odds ratio 6.61 (1.95-22.35), P = 0.001; RVOT septum 5.99 (1.21-29.65), P = 0.028; RVOT free wall 11.86 (1.12-124.78), P = 0.039]. CONCLUSION: Ablation Index-guidance in idiopathic PVCs ablation was associated with better arrhythmic outcomes at 6 months of follow-up. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Paolo Compagnucci; Antonio Dello Russo; Marco Bergonti; Matteo Anselmino; Giulio Zucchelli; Alessio Gasperetti; Laura Cipolletta; Giovanni Volpato; Ciro Ascione; Federico Ferraris; Yari Valeri; Maria Grazia Bongiorni; Andrea Natale; Claudio Tondo; Gaetano Maria De Ferrari; Michela Casella Journal: J Clin Med Date: 2022-03-24 Impact factor: 4.241