Safety and efficacy of atrial fibrillation ablation guided by Ablation Index module

J Interv Card Electrophysiol. 2019 Jan;54(1):9-15. doi: 10.1007/s10840-018-0420-5. Epub 2018 Jul 30.

Abstract

Purpose: Reconnection of pulmonary veins (PVs) remains common following radiofrequency catheter ablation for atrial fibrillation (AF). Ablation Index (AI) is a novel ablation quality marker that incorporates stability, contact force (CF), time, and power in a weighted formula. Its use seems to improve lesion durability. This is a prospective, single-arm registry to investigate on the safety and mid-term efficacy of AF ablation guided by the AI.

Methods: One hundred fifty-six consecutive patients (mean age 58 ± 10 years, 49% males, 44% with structural heart disease) referred for paroxysmal (124) or persistent (32) AF underwent antral PV isolation using a surround flow CF-sensing catheter guided by the AI. Radiofrequency was delivered targeting interlesion distance ≤ 6 mm and Ablation Index of 330-350 at posterior wall and 400-450 at anterior wall.

Results: Mean overall procedure time was 95 ± 30 min with a mean fluoroscopy time of 5 ± 6 min. Mean ablation time was 26 ± 10 min, 627/628 targeted PV were isolated. One pericardial effusion and two groin hematomas were reported; none required intervention. During a mean follow-up of 14 ± 6 months, 17 (10.8%) (9% paroxysmal AF vs 22% persistent AF, p = 0.09) patients had an atrial arrhythmia recurrence.

Conclusions: PV ablation guided by AI resulted feasible, achieving a high rate of isolated PVs, with a low complication rate, and allowed a high single-procedure arrhythmia-free survival at 14 months.

Keywords: Ablation Index; Atrial fibrillation; Catheter ablation; Contact force; Mid-term outcome; Safety.

MeSH terms

  • Aged
  • Atrial Fibrillation / diagnostic imaging
  • Atrial Fibrillation / mortality
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / methods*
  • Catheter Ablation / mortality
  • Chi-Square Distribution
  • Female
  • Fluoroscopy / methods
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Operative Time
  • Patient Safety*
  • Postoperative Care / methods
  • Prognosis
  • Prospective Studies
  • Pulmonary Veins / surgery*
  • Registries
  • Risk Assessment
  • Surgery, Computer-Assisted / methods*
  • Survival Rate
  • Treatment Outcome