Graziana Viola1, Giuseppe Stabile2, Stefano Bandino1, Luca Rossi3, Natale Marrazzo4, Domenico Pecora5, Nicola Bottoni6, Francesco Solimene2, Vincenzo Schillaci2, Marco Scaglione7, Salvatore Ocello8, Claudia Baiocchi9, Amato Santoro9, Stefano Donzelli10, Ermenegildo De Ruvo11, Carlo Lavalle12, Juan Miguel Sanchez-Gomez13, Juan Fernandez Armenta Pastor14, Pilar Cabanas Grandio15, Federico Ferraris16, Antonio Castro17, Luca Rebellato18, Procolo Marchese19, Luis Adao20, Joao Primo21, Sergio Barra21,22, Gavino Casu1,23. 1. San Francesco Hospital, Via Mannironi 1, 08100 Nuoro, Italy. 2. Montevergine Cardiology Clinic, Mercogliano, Italy. 3. Guglielmo da Saliceto Hospital, Piacenza, Italy. 4. Fatebenefratelli Hospital of Benevento, Benevento, Italy. 5. Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy. 6. Santa Maria Nuova Hospital, Reggio Emilia, Italy. 7. Cardinal Massaia Hospital, Asti, Italy. 8. Santissima Trinità Hospital, Cagliari, Italy. 9. Policlinico Santa Maria alle Scotte, Siena, Italy. 10. Santa Maria Hospital, Terni, Italy. 11. Policlinico Casilino, Rome, Italy. 12. Policlinico Umberto I, Rome, Italy. 13. Hospital General Universitario de Castellón, Castellòn de la Plana, Spain. 14. Hospital Universitario Puerta del Mar Càdiz, Cádiz, Spain. 15. Hospital Álvaro Cunqueiro, Vigo, Spain. 16. Le Molinette, Turin, Italy. 17. Sandro Pertini Hospital, Rome, Italy. 18. Santa Maria della Misericordia Hospital, Udine, Italy. 19. Mazzoni Hospital, Ascoli, Italy. 20. Hospital Sao Joao, Porto, Portugal. 21. Hospital da Luz Arrabida, Vila Nova de Gaia, Portugal. 22. Royal Papworth Hospital NHS Trust, Cambridge, UK. 23. Department of Biomedical Science, University of Sassari, Sassari, Italy.
Abstract
AIMS: Ablation index (AI) is a marker of lesion quality during catheter ablation that incorporates contact force, time, and power in a weighted formula. This index was originally developed for pulmonary vein isolation as well as other left atrial procedures. The aim of our study is to evaluate the feasibility and efficacy of the AI for the ablation of the cavotricuspid isthmus (CTI) in patients presenting with typical atrial flutter (AFL). METHODS AND RESULTS: This prospective multicentre non-randomized study enrolled 412 consecutive patients with typical AFL undergoing AI-guided cavotricuspid isthmus ablation. The procedure was performed targeting an AI of 500 and an inter-lesion distance measurement of ≤6 mm. The primary endpoints were CTI 'first-pass' block and persistent block after a 20-min waiting time. Secondary endpoints included procedural and radiofrequency duration and fluoroscopic time. A total of 412 consecutive patients were enrolled in 31 centres (mean age 64.9 ± 9.8; 72.1% males and 27.7% with structural heart disease). The CTI bidirectional 'first-pass' block was reached in 355 patients (88.3%), whereas CTI block at the end of the waiting time was achieved in 405 patients (98.3%). Mean procedural, radiofrequency, and fluoroscopic time were 56.5 ± 28.1, 7.8 ± 4.8, and 1.9 ± 4.8 min, respectively. There were no major procedural complications. There was no significant inter-operator variability in the ability to achieve any of the primary endpoints. CONCLUSION: AI-guided ablation with an inter-lesion distance ≤6 mm represents an effective, safe, and highly reproducible strategy to achieve bidirectional block in the treatment of typical AFL. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Ablation index (AI) is a marker of lesion quality during catheter ablation that incorporates contact force, time, and power in a weighted formula. This index was originally developed for pulmonary vein isolation as well as other left atrial procedures. The aim of our study is to evaluate the feasibility and efficacy of the AI for the ablation of the cavotricuspid isthmus (CTI) in patients presenting with typical atrial flutter (AFL). METHODS AND RESULTS: This prospective multicentre non-randomized study enrolled 412 consecutive patients with typical AFL undergoing AI-guided cavotricuspid isthmus ablation. The procedure was performed targeting an AI of 500 and an inter-lesion distance measurement of ≤6 mm. The primary endpoints were CTI 'first-pass' block and persistent block after a 20-min waiting time. Secondary endpoints included procedural and radiofrequency duration and fluoroscopic time. A total of 412 consecutive patients were enrolled in 31 centres (mean age 64.9 ± 9.8; 72.1% males and 27.7% with structural heart disease). The CTI bidirectional 'first-pass' block was reached in 355 patients (88.3%), whereas CTI block at the end of the waiting time was achieved in 405 patients (98.3%). Mean procedural, radiofrequency, and fluoroscopic time were 56.5 ± 28.1, 7.8 ± 4.8, and 1.9 ± 4.8 min, respectively. There were no major procedural complications. There was no significant inter-operator variability in the ability to achieve any of the primary endpoints. CONCLUSION: AI-guided ablation with an inter-lesion distance ≤6 mm represents an effective, safe, and highly reproducible strategy to achieve bidirectional block in the treatment of typical AFL. 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