Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’-protocol

Section: Discussioncontrasting

confidence: 63%

Comparison of treatment outcomes between convergent procedure and catheter ablation for paroxysmal atrial fibrillation evaluated with implantable loop recorder monitoring

Jan

Žižek

Geršak

et al. 2018

“…Compared to CF and FTI, AI which combines the latter three factors in a weighted equation has been shown to better correlate with lesion depth in an animal model . Recent studies have shown that AI‐guided ablation of atrial fibrillation is superior to CF‐guided ablation. A prospective study by Hussein et al showed that AI‐guided ablation of atrial fibrillation was associated with higher first‐pass pulmonary vein isolation, lower acute pulmonary vein reconnection and lower atrial tachyarrhythmia recurrence rate compared to CF‐guided ablation.…”

Section: Discussionmentioning

confidence: 99%

“…Ablation index (AI; CARTO 3 V4, Biosense Webster, Inc, Diamond Bar, CA), a novel marker of RF application quality that is calculated using a complex weighted exponential formula assigning different weights to power, CF and time, has been shown to accurately estimate lesion depth . AI‐guided ablation is associated with significant improvements in the incidence of acute pulmonary veins reconnection and atrial tachyarrhythmia recurrence rate compared to CF‐guided ablation . However, there is no systematic study on the efficacy of AI‐guided ablation of CTI which is the aim of this study.…”

Section: Introductionmentioning

confidence: 99%

Cavotricuspid isthmus ablation using ablation index in typical right atrial flutter

Zhang

Wang

Han

et al. 2019

Background Ablation index (AI) has been evaluated as guidance quality marker for pulmonary vein isolation, but not for linear ablation of the cavotricuspid isthmus (CTI) for typical right atrial flutter (AFL). We thus studied the feasibility and effectiveness of AI‐guided CTI for AFL. Methods Procedural and 6‐month outcomes of ablation for AFL were retrospectively compared between consecutive patients undergoing either AI‐guided ablation of CTI (n = 43; AI target of 500 for anterior 2/3 segments and 400 for posterior 1/3 segments) or contact force (CF)‐guided ablation (n = 42) at a single center. Each Visitag dataset from all patients in each group was analyzed. Results AI guidance vs CF guidance was associated with: higher first‐pass conduction block of CTI (93.0% vs 76.2%, P = .03) with similar ablation time; similar acute spontaneous CTI reconnection 2.3% vs 9.5%, P = .343); fewer radiofrequency (RF) applications (10.1 ± 2.8 vs 11.5 ± 3.0, P = .031) needed to achieve CTI directional block; significantly higher mean ablation time, impedance drop, force time integral and AI and similar mean CF and power of each VisiTag point. One inguinal hematoma and one pseudoaneurysm developed in the AI and CF groups, respectively. Recurrent AFL was recorded in two (4.7%) AI‐group patients and four (9.5%) CF‐group patients (P = .650). Conclusion AI‐guided ablation of CTI line for AFL appears feasible and effective with similar ablation time, fewer RF applications, a higher rate of first‐pass conduction block, and no additional complications.

“…Our data indicate that AI‐guided ablation may also be safe in regard to creating low incidences of EDELs by potentially reducing local energy and ablation time to a minimum needed for adequate lesion formation but not more. AI‐guided ablation has been documented to improve the procedural and long‐term outcome of AF ablation but randomized trials documenting efficacy on the one hand and safety on the other hand are lacking …”

Section: Discussionmentioning

confidence: 99%

“…These parameters might also predict the risk of postprocedural esophageal thermal lesions (EDELs) induced by RF ablation at posterior left atrial (LA) wall. In a recent study, improved acute and 12‐month efficacy were documented using ablation index (AI)—a novel parameter defining energy application at single ablation sites, calculated by integration of catheter stability, ablation time, ablation energy, and contact force—to guide local RF applications …”

Section: Introductionmentioning

confidence: 99%

Incidence of acute thermal esophageal injury after atrial fibrillation ablation guided by prespecified ablation index

Halbfaß

Berkovitz

Павлов

et al. 2019

Introduction Ablation index (AI), a novel parameter defining energy application at single ablation lesions, calculated by integration of ablation time, energy, catheter stability, and contact force, has been documented to be associated with effective lesions and higher ablation efficacy. Using a prespecified target AI in addition to acute lesion efficacy may affect local collateral damage like esophageal thermal injury when used for guiding radiofrequency (RF) ablation at the posterior left atrial (LA) wall. Methods and Results Consecutive patients undergoing first AF ablations using AI were included. Ablation energy was reduced to 25 W when ablating at posterior LA wall. Two different individually defined AI target values were used (300 and 350 for posterior wall ablation). Esophageal endoscopy (EE) was performed 1 to 3 days after ablation procedure to document and categorize endoscopically detected esophageal thermal lesion (EDEL). Two‐hundred and eleven consecutive patients with postprocedural EE were included. Incidence of EDEL was 14% (29 of 211 patients; mild category 1 lesions in 22 of 29 patients (76%) and severe category 2 lesions (ulcers > 5 mm) in 7 of 29 patients (24% of EDEL group, 3% of total group). Ablation time at posterior LA wall (9.5 vs 9.0 minutes [P = .67]) was comparable in patients with and without EDEL. Conclusion LA posterior wall RF ablation adopting AI ≤350 was associated with 14% esophageal thermal injury including 3% of severe esophageal thermal ulcers. This incidence is comparable to historic control groups with non AI–guided AF ablation.