Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values

Das, Moloy; Loveday, Jonathan J.; Wynn, Gareth J.; Gomes, Sean; Saeed, Yawer; Bonnett, Laura; Waktare, Johan; Todd, Derick; Hall, Mark; Snowdon, Richard; Modi, Simon; Gupta, Dhiraj

doi:10.1093/europace/euw105

Cited by 220 publications

(340 citation statements)

References 20 publications

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“…In the bottom, we plotted the specificity, sensitivity, positive predictive value, and negative predictive value to discriminate durable segments at known clinical cutoffs. 11,12,14 Both at the anterior and posterior walls, ALCI was invariably associated with the highest specificity and positive predictive value to discriminate a durable segment.…”

Section: Comparison Of Segments With or Without Pvr In Anterior And Pmentioning

confidence: 91%

“…By taking into account the greater contribution of power (over CF) and of the initial time of ablation, it differs from force-power-time integral calculated as the multiplication of force, power, and time. 20 Das el al 11 recently showed that AI correlated with impedance drop and that minimal AI within a segment was predictive of reconnection at that segment at repeat electrophysiology study. Our data confirm that there is a significant difference in minimal AI values required to obtain durable segments in the anterior part of the circle (>644 au) compared with the posterior segments (>437 au), suggestive of thicker atrial tissue in anterior regions.…”

Section: Ai and Its Putative Role As Ablation Target Valuesmentioning

confidence: 99%

“…Criteria for lesion depth implied time of application, median delivered power, impedance drop, average CF, force-time integral (FTI), and ablation index (AI). 10,11 Contiguity was assessed by calculating automated interlesion distance. Ablation line contiguity index (ALCI) was developed as a novel automated algorithm to assess both depth and contiguity.…”

mentioning

confidence: 99%

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Determinants of Acute and Late Pulmonary Vein Reconnection in Contact Force–Guided Pulmonary Vein Isolation

Haddad

Taghji

Phlips

et al. 2017

Circ: Arrhythmia and Electrophysiology

142

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From August 2013, all patients undergoing CF-guided ablation for AF were followed in a prospective database approved by the local © 2017 American Heart Association, Inc. , and higher ILD max (6.8 versus 5.5 mm). ALCI min was significantly lower in segments with PVR (74% versus 104%; P˂0.001) and was associated with the highest accuracy to predict durable segments (area under the curve=0.73). Conclusions-In CF-guided pulmonary vein isolation, PVR is explained by lack of both lesion depth and contiguity within the deployed radiofrequency circle. ALCI, a novel measure combining contiguity and depth, is the most accurate predictor for durable segments. By avoiding weak links in the ablation chain, ALCI-guided ablation is expected to improve success rate of point-by-point radiofrequency ablation. (Circ Arrhythm Electrophysiol. 2017;10:e004867.

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Section: Comparison Of Segments With or Without Pvr In Anterior And Pmentioning

confidence: 91%

Section: Ai and Its Putative Role As Ablation Target Valuesmentioning

confidence: 99%

See 1 more Smart Citation

Determinants of Acute and Late Pulmonary Vein Reconnection in Contact Force–Guided Pulmonary Vein Isolation

Haddad

Taghji

Phlips

et al. 2017

Circ: Arrhythmia and Electrophysiology

142

View full text Add to dashboard Cite

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“…Das et al reported that FTI of 230 g was associated with no reconnection of the posterior/ inferior segments at repeat electrophysiology study. 27 Although FTI was proposed as a marker to assess lesion formation and widely used for AF ablation, universal consensus has not been reached on the value required to create a durable lesion.…”

Section: Efficacy Of Pvai For Afmentioning

confidence: 99%

“…A novel marker of ablation lesion formation that incorporates power in addition to CF and time in a weighted formula was found to accurately estimate ablation lesion depth. 27 This formula, termed as the ablation index, was reported to reduce the incidence of acute PV reconnection and atrial tachyarrhythmia recurrence rates compared with CF-guided ablation. 28 Further studies are needed to confirm its efficacy.…”

Section: Efficacy Of Pvai For Afmentioning

confidence: 99%

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―

Okamatsu

Okumura

2018

Circ J

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ablation lesion. These novel technologies will promisingly bring new strategies of ablation and enhanced effectiveness and safety. Here, we review the previous reports on catheter ablation for persistent AF, and then introduce possible strategies for persistent AF ablation under concomitant use of the new technologies. Previous Reports on Ablation Strategies for Persistent AFPrior common procedures for persistent AF ablation include creation of linear lesions in the left atrium (LA) and focal ablation targeting complex fractionated electrograms (CFAEs Since the landmark study of Haïssaguerre et al demonstrating that the triggers initiating atrial fibrillation (AF) originate from the pulmonary veins (PVs), catheter ablation targeting PV has become an established strategy for paroxysmal AF. 1 The recognition that AF trigger sites were located within the PV antrum in the majority of cases led to extended, circumferential PV antrum isolation (PVAI) as an ablation procedure for AF. The recurrence of atrial tachyarrhythmias was reported to be significantly less in patients with large isolation areas around both ipsilateral PVs than in those with segmental PV isolation. 2 A recent study showed that, in patients with paroxysmal AF undergoing extended PVAI, the rate of late recurrence was lower than that previously reported with segmental or less extensive antral isolation. 3 Today, PVAI is the cornerstone of catheter-based therapies for paroxysmal AF. However, the success rates of catheter ablation in cases of persistent AF are significantly lower than those for paroxysmal AF. Progressive atrial remodeling in persistent AF has been regarded as a reason for the low efficacy of the treatment in persistent AF. Therefore, additional ablation strategies for modifying and eliminating the AF-sustaining atrial substrate have been developed and challenged.Recently, there has been technological progress in both 3D mapping systems and ablation catheters, which enable us to create precise high-resolution mapping and a durable Pulmonary vein (PV) antrum isolation (PVAI) is effective in treating paroxysmal atrial fibrillation (AF) but is less so for persistent AF. A recent randomized study on the ablation strategies for persistent AF demonstrated that 2 common atrial substrate modifications, creation of linear lesions in the left atrium and ablation of complex fractionated electrogram sites, in addition to PVAI did not improve the outcome compared with stand-alone PVAI, suggesting the necessity of a more individualized, selective approach to persistent AF. There are emerging technologies, including high-resolution mapping with the use of multi-electrode catheter and auto mapping system and contact force (CF) guide ablation; the former allows rapid and accurate confirmation of the completeness of PVAI, and the latter enhances the achievement of durable ablation lesions more securely. Ablation for fibrotic area(s) has been proposed as a new approach for substrate modification, and high-resolution mapping is useful to define the area ...

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Standard vs Augmented Ablation of Paroxysmal Atrial Fibrillation for Reduction of Atrial Fibrillation Recurrence

et al. 2023

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ImportanceRecurrent atrial fibrillation (AF) commonly occurs after catheter ablation and is associated with patient morbidity and health care costs.ObjectiveTo evaluate the superiority of an augmented double wide-area circumferential ablation (WACA) compared with a standard single WACA in preventing recurrent atrial arrhythmias (AA) (atrial tachycardia, atrial flutter, or atrial fibrillation [AF]) in patients with paroxysmal AF.Design, Setting, and ParticipantsThis was a pragmatic, multicenter, prospective, randomized, open, blinded end point superiority clinical trial conducted at 10 university-affiliated centers in Canada. The trial enrolled patients 18 years and older with symptomatic paroxysmal AF from March 2015 to May 2017. Analysis took place between January and April 2022. Analyses were intention to treat.InterventionsPatients were randomized (1:1) to receive radiofrequency catheter ablation for pulmonary vein isolation with either a standard single WACA or an augmented double WACA.Main Outcomes and MeasuresThe primary outcome was AA recurrence between 91 and 365 days postablation. Patients underwent 42 days of ambulatory electrocardiography monitoring after ablation. Secondary outcomes included need for repeated catheter ablation and procedural and safety variables.ResultsOf 398 patients, 195 were randomized to the single WACA (control) arm (mean [SD] age, 60.6 [9.3] years; 65 [33.3%] female) and 203 to the double WACA (experimental) arm (mean [SD] age, 61.5 [9.3] years; 66 [32.5%] female). Overall, 52 patients (26.7%) in the single WACA arm and 50 patients (24.6%) in the double WACA arm had recurrent AA at 1 year (relative risk, 0.92; 95% CI, 0.66-1.29; P = .64). Twenty patients (10.3%) in the single WACA arm and 15 patients (7.4%) in the double WACA arm underwent repeated catheter ablation (relative risk, 0.72; 95% CI, 0.38-1.36). Adjudicated serious adverse events occurred in 13 patients (6.7%) in the single WACA arm and 14 patients (6.9%) in the double WACA arm.Conclusions and RelevanceIn this randomized clinical trial of patients with paroxysmal AF, additional ablation by performing a double ablation lesion set did not result in improved freedom from recurrent AA compared with a standard single ablation set.Trial RegistrationClinicalTrials.gov Identifier: NCT02150902

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Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values

Abstract: The minimum AI value in a PVI segment is independently predictive of reconnection of that segment at repeat electrophysiology study. Higher AI and FTI values are required for anterior/roof segments than for posterior/inferior segments to prevent reconnection.

Cited by 220 publications

References 20 publications

Determinants of Acute and Late Pulmonary Vein Reconnection in Contact Force–Guided Pulmonary Vein Isolation

Determinants of Acute and Late Pulmonary Vein Reconnection in Contact Force–Guided Pulmonary Vein Isolation

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―

Standard vs Augmented Ablation of Paroxysmal Atrial Fibrillation for Reduction of Atrial Fibrillation Recurrence

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Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values

Abstract: The minimum AI value in a PVI segment is independently predictive of reconnection of that segment at repeat electrophysiology study. Higher AI and FTI values are required for anterior/roof segments than for posterior/inferior segments to prevent reconnection.

Cited by 220 publications

References 20 publications

Determinants of Acute and Late Pulmonary Vein Reconnection in Contact Force–Guided Pulmonary Vein Isolation

Determinants of Acute and Late Pulmonary Vein Reconnection in Contact Force–Guided Pulmonary Vein Isolation

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation ― Impact of Progress in the Mapping and Ablation Technologies ―

Standard vs Augmented Ablation of Paroxysmal Atrial Fibrillation for Reduction of Atrial Fibrillation Recurrence

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Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―