The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.
Background Ablation index (AI) is a new lesion quality marker that has been demonstrated to allow a high single‐procedure arrhythmia‐free survival in single‐center studies. This prospective, multi‐center study was designed to evaluate the reproducibility of pulmonary vein (PV) isolation guided by the AI. Methods A total of 490 consecutive patients with paroxysmal (80.4%) and persistent AF underwent first time PV isolation and were divided in four study groups according to operator's preference in choosing the ablation catheter (a contact force (ST) or contact force surround flow (STSF) catheter) and the AI setting (330‐450 or 380‐500 at anterior wall or posterior wall, respectively). Results At 12 months a high rate of freedom from AF recurrences was observed in patients with both paroxysmal and persistent AF (91% vs 83.3%; P = .039). There was no difference in the rate of AF recurrence among the four study groups (4.5% in group ST330‐450, 12.2% in group ST 380‐500, 14.9% in group STSF330‐450, 9.4% in group STSF380‐500; P = .083). Recurrence was also similar between patients treated with a ST (8%) or STSF catheter (12.1%; P = .2), and within patients targeting an AI settings of 330 to 450 (10.9%) or 380 to 500 (10.3%; P = .64). In patients with paroxysmal AF, there was no difference (P = .12) in the 1‐year freedom from AF recurrence among 14 operators that performed ≥10 ablation procedure. Conclusions An ablation protocol respecting strict criteria for contiguity and quality lesion resulted in high rate of 1‐year freedom from AF recurrence, irrespective of the ablation catheters, AI settings, and operator.
This observational registry showed that PAF ablation with a CF-sensing catheter had high acute success rates, favourable 12-month outcomes, and a good safety profile. Patients' QoL improved significantly. Long-term effectiveness significantly correlated with stable CF with adequate catheter-tissue contact (NCT01677052).
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. MethodsThe Ablation Index Registry is a multicentre study that included patients with paroxysmal/persistent atrial fibrillation (AF) 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 in 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 minutes after PVI, whereas the incidence of late PVR was evaluated at repeat procedure.Results Overall, 490 patients were divided in Group 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of 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 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. ConclusionAblation with lower range of AI is highly effective and is not associated with higher rate of acute and late PVR. No predictors of PV reconnection were found.
Purpose: Wedging a circular mapping catheter (CMC) into pulmonary vein (PV) is recommended to validate their isolation during wide antral circumferential ablation (WACA). Since appropriate catheter contact has proved crucial for lesion quality, we hypothesize that a contactforce (CF) guided single catheter approach might be suitable and effective for PV isolation (PVI). Methods: With the use of a CF ablation catheter, WACA was performed for both sets of PVs in 50 patients with paroxysmal AF. Antral exit block was demonstrated by sequential pacing at 9 equidistant points within the circular WACA lesion set (including the carina), with a target force ! 10g. Sites displaying persistent left atrial capture underwent additional pacing maneuvers and electrogram analysis, in order to detect and close residual gaps. Once exit block was deemed achieved, PVI was validated by conventional CMC-based analysis. Results: The mean procedural duration, fluoroscopy exposure time, total ablation time and force applied per-procedure were respectively of 101 + 17 min, 5.6 + 2.2 min, 23.2 + 7.1 min and 17.8 + 2.6 grams. 84 of 100 PV antra were disconnected after an exclusive anatomical approach, while 16 displayed residual gaps. Of the latter, 14 were isolated with the sole CF catheter. The positive predictive value of antral exit block reached 100% for predicting PVI as assessed with CMC. Conclusions: CF-guided single catheter technique is a feasible method for PVI in patients with paroxysmal AF. This simplified approach proves as effective as the standard CMC-based approach for residual gaps identification and conduction block validation. Introduction: The impact of power, ablation time and contact force (CF) alone on lesion formation in atrial fibrillation ablation has been proven. However, the interaction and collective effect of these factors on ablation effectiveness has not been clearly elucidated. Methods: 416 ablation points were acquired from 19 patients with paroxysmal atrial fibrillation who underwent pulmonary vein isolation for the first time. The points were collected at the beginning of the procedure at separate sites to avoid the mutual effect. A Thermocool SmartTouch catheter was used for radiofrequency ablation. Energy was applied for 60 s at every site under the same power setting. All data including ablation time, power, CF and impedance were recorded on a Carto 3 system and analyzed off-line. Impedance drop (ID) was used as a surrogate for evaluating ablation effectiveness and ID ! 10V regarded as an adequate lesion formation. Data were grouped by power (25W, n ¼ 115, 30W, n ¼ 166, and 35W, n ¼ 135) and average CF (,5g, 5-10g, 11-20g and .20g) for analysis. Results: When CF was ,5g, IDs did not raise with power increase and never crossed 10V. When CF was !5g, IDs were getting higher when power or CF increased. This effect was observed from 0-40s but not after 40s. When CF over 20g and power over 30W, there was a tendency that impedance rose again. (Figure) Conclusions: When CF ,5g, ablation effect cannot be im...
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