A Lepillier1, T Strisciuglio2,3, E De Ruvo4, M Scaglione5, M Anselmino6, F A Sebag7, D Pecora8, M M Gallagher9, M Rillo10, G Viola11, E Pisanò12, S Abbey13, F Lamberti14, A Pani15, G Zucchelli16, G Sgarito17, A De Simone18, E Bertaglia19, F Solimene2, Giuseppe Stabile20,21,22. 1. Centre Cardiologique du Nord, St Denis, Paris, France. 2. Clinica Montevergine, Mercogliano, Avellino, Italy. 3. University of Naples Federico II, Naples, Italy. 4. Policlinico Casilino, Roma, Italy. 5. Ospedale Cardinal Massaia, Asti, Italy. 6. A.O.U. Citta della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, Turin, Italy. 7. Institut Mutualiste Montsouris, Paris, France. 8. Fondazione Poliambulanza, Brescia, Italy. 9. St George's Hospital, London, UK. 10. Casa di Cura Villa Verde, Taranto, Italy. 11. Ospedale San Francesco, Nuoro, Italy. 12. Ospedale Vito Fazzi, Lecce, Italy. 13. Hôpital Privé Du Confluent (HPCN), Nantes, France. 14. Ospedale Sant'Eugenio, Roma, Italy. 15. Ospedale di Lecco, Lecco, Italy. 16. Azienda Ospedaliera Pisana, Pisa, Italy. 17. A.R.N.A.S. Civico Cristina Benfratelli, Palermo, Italy. 18. Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy. 19. Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy. 20. Clinica Montevergine, Mercogliano, Avellino, Italy. gmrstabile@tin.it. 21. Clinica San Michele, via Montella 16, 81024, Maddaloni, Caserta, Italy. gmrstabile@tin.it. 22. Anthea Hospital, Bari, Italy. gmrstabile@tin.it.
Abstract
PURPOSE: Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors. METHODS: The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure. RESULTS: Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found. CONCLUSION: Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.
PURPOSE: Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors. METHODS: The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure. RESULTS: Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found. CONCLUSION: Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.
Authors: Thomas Phlips; Philippe Taghji; Milad El Haddad; Michael Wolf; Sébastien Knecht; Yves Vandekerckhove; René Tavernier; Mattias Duytschaever Journal: Europace Date: 2018-11-01 Impact factor: 5.214
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Francesco Solimene; Antoine Lepillier; Ermenegildo De Ruvo; Marco Scaglione; Matteo Anselmino; Frederic A Sebag; Domenico Pecora; Mark M Gallagher; Mariano Rillo; Graziana Viola; Luca Rossi; Valerio De Santis; Maurizio Landolina; Antonello Castro; Massimo Grimaldi; Nicolas Badenco; Maurizio Del Greco; Antonio De Simone; Emanuele Bertaglia; Giuseppe Stabile Journal: Pacing Clin Electrophysiol Date: 2019-05-21 Impact factor: 1.976
Authors: Moloy Das; Jonathan J Loveday; Gareth J Wynn; Sean Gomes; Yawer Saeed; Laura J Bonnett; Johan E P Waktare; Derick M Todd; Mark C S Hall; Richard L Snowdon; Simon Modi; Dhiraj Gupta Journal: Europace Date: 2017-05-01 Impact factor: 5.214