Optimized lesion size index (o‐LSI): A novel predictor for sufficient ablation of pulmonary vein isolation

Matsuura, Gen; Kishihara, Jun; Fukaya, Hidehira; Oikawa, Jun; Ishizue, Naruya; Saito, Daiki; Sato, Tetsuro; Arakawa, Yuki; Kobayashi, Shuhei; Yuki, Satoshi; Nishinarita, Ryo; Horiguchi, Akio; Niwano, Shinichi; Ako, Junya

doi:10.1002/joa3.12537

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…Given the above results, we speculated that a real-time measurement of LSI during PVI might reflected the tissue lesion at non-posterior wall of PV in human bodies. Although the LSI has been well established, it is sometimes difficult to achieve first-pass PVI even with LSI-guided procedures ( 25 ). In our study, we found LSI was less accurate in determining acute ablation lesion at posterior wall of PV than at other areas under the ablation line.…”

Section: Discussionmentioning

confidence: 99%

Quantitative late gadolinium enhancement cardiac magnetic resonance analysis of the relationship between ablation parameter and left atrial tissue lesion following pulmonary vein isolation

Wang

Huang²,

Huo³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe impact of ablation parameters on acute tissue lesion formation after pulmonary vein isolation (PVI) has not been sufficiently evaluated in patients with atrial fibrillation. Radiofrequency ablation lesion can be visualized by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). We sought to quantitatively analyze the relationship between ablation parameter and tissue lesion following PVI at different segments of pulmonary vein (PV) using LGE-CMR.MethodsTwenty-one patients with atrial fibrillation who underwent PVI procedure were retrospectively enrolled. All patients underwent LGE-CMR examination within 3 days after radiofrequency ablation. Ablation parameters during PVI were documented, including lesion size index (LSI), force–time integral (FTI), power, contact force, temperature, and time of duration. The ablation point was projected onto 3-dimensional (3D) left atrial shell constructed base on LGE-CMR and corresponding image intensity ratio (IIR) was calculated on the same shell. A tissue lesion point was defined when the LGE-CMR IIR was > 1.2.ResultsIn total, 1,759 ablation points were analyzed. The ablation parameters and IIRs for each PV segment were significantly different (P < 0.0001). IIRs corresponding to ablation points at posterior of PV tended to be higher than those at non-posterior of PV when similar ablation parameters were applied during ablation. LSI was a better predictor of tissue lesion existence following PVI than FTI, contact force, power, temperature, and duration time at non-posterior wall of PV. The IIR showed positive correlation with LSI at non-posterior wall of PV (non-posterior of right PV, r = 0.13, P = 0.001, non-posterior of left PV, r = 0.26, P < 0.0001).ConclusionWhen similar ablation parameters were applied during PVI, the posterior wall of PV had more severe tissue lesion than non-posterior wall of PV. Therefore, it was reasonable to decrease ablation energy at posterior wall of PV. Moreover, LSI was a better index to reflect tissue lesion quality following PVI at non-posterior of PV.

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Section: Discussionmentioning

confidence: 99%

Quantitative late gadolinium enhancement cardiac magnetic resonance analysis of the relationship between ablation parameter and left atrial tissue lesion following pulmonary vein isolation

Wang

Huang²,

Huo³

et al. 2023

Front. Cardiovasc. Med.

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“…Some studies suggest a 5–10 Ω decrease in resistance or a ≥50% decrease in the bipolar amplitude of local electrograms are evidence of lesion formation with perfused radiofrequency ablation catheters. On the other hand, the efficacy of RF ablation using LSI has been demonstrated in various reports 14 and has become the standard indicator. In our study, the amount of impedance drop and amplitude decrease were well correlated with the impedance and amplitude just before ablation when the target LSI was set to 4.5 on the posterior wall and 5.2 on the anterior wall.…”

Section: Discussionmentioning

confidence: 99%

“…All ablation point data are shown in Table 2. The median impedance drop was 16 [13][14][15][16][17][18][19][20] Ω.…”

Section: Impedance Drop Analysismentioning

confidence: 99%

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Evaluation and comparison of impedance and amplitude changes in lesion index‐guided pulmonary vein isolation

Kaneko,

Naruse,

Narumi

et al. 2023

Journal of Arrhythmia

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BackgroundThe lesion index (LSI) has been used to estimate lesion formation after radiofrequency catheter ablation. However, the impedance drop and decrease in bipolar amplitude of intracardiac electrograms, which are parameters that are traditionally used to predict effective ablation lesions, are not used to calculate LSI. Therefore, we aimed to investigate the association between LSI and traditional parameters.MethodsWe retrospectively investigated 1355 ablation points from 31 patients who underwent LSI‐guided pulmonary vein isolation (PVI) using TactiCath. All points were classified into 3 groups based on the impedance drop: (i) <10 Ω (n = 67), (ii) 10–20 Ω (n = 909), and (iii) >20 Ω (n = 379). The LSI targets were 4.5 for the posterior left atrium and 5.2 for the anterior left atrium. After excluding 583 points at which it was difficult to measure the amplitude, 772 ablation points during sinus rhythm were included in the analysis of bipolar amplitude.ResultsThe target LSI was achieved at 1177 points (86.9%). The median total impedance drop and amplitude just after ablation were 16.0 [13.0–20.0] Ω and 0.21 [0.14–0.30] mV, respectively. There were significant differences among the 3 groups in the impedance and amplitude before ablation, power, target LSI, final LSI, contact force, and interlesion distance. An impedance drop of >10 Ω or an amplitude reduction of >50% was achieved at 95% and 82% of the study points, respectively. There were no major complications at any of the ablation points.ConclusionLSI‐guided PVI seemed to be useful for making sufficient ablation lesions, as assessed by the conventional parameters of impedance and amplitude change.

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“…We used a Swartz sheath (St. Jude Medical) for LA ablation, but did not use a steerable sheath. A point-by-point PVI was performed with the target contact force sensing > 10 g, lesion index > 4–5, and lesion distance of 4 mm, if necessary [ 16 , 17 ]. The lesion index was monitored during the PVI.…”

Section: Methodsmentioning

confidence: 99%

Comparison of the empirical linear ablation and low voltage area-guided ablation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation: a propensity score-matched analysis

Suzuki

Kaneko

Fujita

et al. 2022

BMC Cardiovasc Disord

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Background The efficacy of pulmonary vein isolation (PVI) alone is not guaranteed for persistent atrial fibrillation (PeAF), and it is unclear which type of ablation approach should be applied in addition to PVI. This study aimed to compare outcomes and prognosis between empirical linear ablation and low-voltage area (LVA) ablation after PVI for PeAF. Methods We enrolled 128 patients with PeAF who were assigned to the linear ablation group (n = 64) and the LVA ablation group (n = 64) using a propensity score-matched model. After PVI and cardioversion, the patients underwent either empirical linear ablation or LVA ablation during sinus rhythm. All patients in the linear ablation group underwent both roof line and mitral valve isthmus (MVI) ablations. An electrical-guided ablation targeting LVA (< 0.5 mV) was performed in the LVA group. When there was no LVA in the LVA group, only PVI was applied. We compared the procedural outcomes and recurrence after ablation between the two groups. Results The baseline characteristics were well-balanced between the two groups. Fifty patients had LVA (22 and 28 patients in the linear and LVA groups). The roof and MVI lines were completed in 100% and 96.9% of the patients. During the mean follow-up of 279.5 ± 161.3 days, the LVA group had significantly lower recurrence than the linear group (15 patients [23%] vs. 29 patients [45%], p = 0.014). Thirty-five patients were prescribed antiarrhythmic drugs during the follow-up period (linear group, n = 17; LVA group, n = 18); amiodarone and bepridil were administered to most of the patients (15 and 17 patients, respectively). The difference in the prognosis was relevant among the patients with LVA, while this trend was not observed in those without LVA. The LVA ablation group demonstrated significantly lower radiofrequency energy and shorter procedural time compared to the linear ablation group. The recurrence of atrial flutter was more likely to occur in the linear group than in the LVA group (14 [22%] vs. 6 [9.4%], p = 0.052). Conclusion The electrophysiological-guided LVA ablation is more effective than empirical linear ablation in PeAF patients with LVA. Unnecessary empirical linear ablation might have a risk of iatrogenic gap and atrial flutter recurrence.

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Optimized lesion size index (o‐LSI): A novel predictor for sufficient ablation of pulmonary vein isolation

Cited by 7 publications

References 19 publications

Quantitative late gadolinium enhancement cardiac magnetic resonance analysis of the relationship between ablation parameter and left atrial tissue lesion following pulmonary vein isolation

Quantitative late gadolinium enhancement cardiac magnetic resonance analysis of the relationship between ablation parameter and left atrial tissue lesion following pulmonary vein isolation

Evaluation and comparison of impedance and amplitude changes in lesion index‐guided pulmonary vein isolation

Comparison of the empirical linear ablation and low voltage area-guided ablation in addition to pulmonary vein isolation in patients with persistent atrial fibrillation: a propensity score-matched analysis

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