Automated Ablation Annotation Algorithm Reduces Re-conduction of Isolated Pulmonary Vein and Improves Outcome After Catheter Ablation for Atrial Fibrillation

Abstract

VISITAG Module) uses an algorithm for the automated annotation of RF ablation applications based on objective, predefined parameters. Because it provides crucial information on catheter stability and ablation intensity at each site, it may be helpful in accomplishing durable PVI.The aim of this study was therefore to evaluate the utility of automated ablation lesion annotation by comparing procedure parameters and outcomes between automated annotation-guided and non-guided procedures. Methods SubjectsThe study was conducted under a retrospective, singlecenter observational design. We included 91 AF patients who underwent initial PVI by an experienced operator between June 2013 and January 2015. We performed 51 initial AF ablations from June 2014 to January 2015. We C atheter ablation (CA) is an effective therapy of atrial fibrillation (AF). The cornerstone of CA for AF is pulmonary vein isolation (PVI). 1,2 Despite initially successful PVI, however, recurrence of AF after CA occurs frequently and is often related to the recovery of conduction between the pulmonary vein (PV) and left atrium (LA). 3-5 Contact force (CF) monitoring of the ablation catheter might help achieve more durable lesions and substantially improve procedural outcomes. 6 A recent randomized, multicenter study, however, showed that CF data availability was associated with reduced acute PV reconnections but not improved 1-year success rates, procedure and fluoroscopy times, or complication rates. 7 The failure of CF monitoring to improve clinical outcome of AF ablation might be due to a lack of information on the catheter stability as well as the precise location of ablated lesions, and subsequent heterogeneous ablation intensity. Background: Durable pulmonary vein isolation (PVI) is critical in reducing recurrence after radiofrequency catheter ablation for atrial fibrillation (AF). The VISITAG Module, an automatic annotation system that takes account of catheter stability and contact force (CF), might be useful in accomplishing this.

Circumferential pulmonary vein antrum ablation for the treatment of paroxysmal atrial fibrillation: A randomized controlled trial

“…20 Our study is unique because it uses an automated radiofrequency application display module, which integrates CF with catheter stability and ablation time, thus allowing quantitative control of the lesion set at the PV antrum. 21 In fact, the PVAM group (including the two subgroups) demonstrated a more adequate contact control than the CPVI group.…”

“…To date, there have been few clinical trials dedicated to the investigation of the use of an automated module in the ablation of AF. 21 Our ablation setting was a comprehensive consideration for safety and efficacy based on previous data regarding the CF setting and the corporation recommendations. [25][26][27][28] With CF, lesions can be quantitatively deployed, and the lesion size can be reliably assessed.…”

Analysis of late reconnections after pulmonary vein isolation: Impact of interlesion contiguity and ablation index

“…The RF lesion quality is determined based on predefined parameters of stability, time, and CF. Several studies have shown that PVI guided by automatic annotation of RF tags is associated with higher acute success rate and better long‐term outcomes compared with conventional PVI . It has been proposed that RF applications that meet automatic annotation criteria achieve greater lesion durability .…”

“…Several studies have shown that PVI guided by automatic annotation of RF tags is associated with higher acute success rate and better long-term outcomes compared with conventional PVI. 13,17 It has been proposed that RF applications that meet automatic annotation criteria achieve greater lesion durability. 13 However, it has not been shown that conventional applications are associated with a higher risk of late PVR.…”

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

“…The 3D mapping systems with automatic lesion index integration of contact‐force feedback help to visualize and evaluate the efficiency and stability of lesions along the ablation line . Additionally, AF ablation with contact‐force technology and strict criteria of stability was reported as a safe procedure and is associated with an improvement in efficiency and a reduction in AF recurrence …”