Journal
EUROPACE
Volume 24, Issue 3, Pages 390-399Publisher
OXFORD UNIV PRESS
DOI: 10.1093/europace/euab216
Keywords
Ablation index; Atrial fibrillation; Atrial wall thickness; Catheter ablation
Categories
Funding
- Swiss Heart Rhythm Foundation
- Sociedad Espanola de Cardiologia (SEC)
Ask authors/readers for more resources
The study aimed to determine the feasibility, effectiveness, and safety of adapting the ablation index (AI) to the left atrial wall thickness (LAWT) during paroxysmal atrial fibrillation (PAF) ablation. The results showed that personalized AF ablation based on LAWT allowed for pulmonary vein isolation with low RF delivery, fluoroscopy, and procedure time, with a high rate of first-pass isolation and a high freedom from AF recurrences in the patient population.
Aims To determine if adapting the ablation index (AI) to the left atrial wall thickness (LAWT), which is a determinant of lesion transmurality, is feasible, effective, and safe during paroxysmal atrial fibrillation (PAF) ablation. Methods and results Consecutive patients referred for PAF first ablation. Left atrial wall thickness three-dimensional maps were obtained from multidetector computed tomography and integrated into the CARTO navigation system. Left atrial wall thickness was categorized into 1 mm layers and AI was titrated to the LAWT. The ablation line was personalized to avoid thicker regions. Primary endpoints were acute efficacy and safety, and freedom from atrial fibrillation (AF) recurrences. Follow-up (FU) was scheduled at 1, 3, 6, and every 6 months thereafter. Ninety patients [60 (67%) male, age 58 +/- 13 years] were included. Mean LAWT was 1.25 +/- 0.62 mm. Mean AI was 366 +/- 26 on the right pulmonary veins with a first-pass isolation in 84 (93%) patients and 380 +/- 42 on the left pulmonary veins with first-pass in 87 (97%). Procedure time was 59 min (49-66); radiofrequency (RF) time 14 min (12.5-16); and fluoroscopy time 0.7 min (0.5-1.4). No major complication occurred. Eighty-four out of 90 (93.3%) patients were free of recurrence after a mean FU of 16 +/- 4 months. Conclusion Personalized AF ablation, adapting the AI to LAWT allowed pulmonary vein isolation with low RF delivery, fluoroscopy, and procedure time while obtaining a high rate of first-pass isolation, in this patient population. Freedom from AF recurrences was as high as in more demanding ablation protocols. A multicentre trial is ongoing to evaluate reproducibility of these results.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available