Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation

Abstract

Introduction Contact force (CF) guided ablation of paroxysmal atrial fibrillation (PAF) with stable catheter‐tissue contact optimizes clinical success and may increase an operator's ability to achieve pulmonary vein isolation (PVI) in a single encirclement. First pass PVI reduces procedure time but the relationship with long term clinical success is not well understood. This study evaluated patient characteristics and procedural details as predictors of 1‐year clinical success after PAF ablation, including first pass isolation. Methods Consecutive de novo PAF ablations were performed with a porous tip CF catheter in 2017 and 2018. All ablations used wide‐area circumferential ablation, with first pass isolation captured separately for the left and right pulmonary veins (PVs). CF was held between 10 and 20 g and the catheter was moved every 10–20 s. Radiofrequency energy was set at 40–45 W throughout the atrium. Patient characteristics and procedural details were tested for association with clinical success, defined as freedom from recurrent atrial tachyarrhythmia through 1 year. Results A total of 404 patients were included in the study. Clinical success at 1 year was 86.6%. Achieving first pass isolation on at least one ipsilateral PV pair was the most significant predictor of clinical success (p = .0126). After controlling for first pass isolation, only recurrence within the 90‐day blanking period was independently predictive (p = .0015). First pass isolation was not associated with early recurrence (p = .2454). Conclusion In a real‐world setting, first pass isolation was highly predictive of 12‐month clinical success after CF‐guided ablation in a PAF population.

Ablation Index-Guided High-Power Radiofrequency Application Shortens the Procedure Time With Similar Outcomes to Conventional Power Application in Atrial Fibrillation Ablation

“…Osorio et al reported that first-pass isolation on at least one side was an independent predictor of atrial tachyarrhythmia recurrence-free survival after PVI. 20 However, Osorio et al also showed that first-pass isolation on both sides, which was generally used as first-pass isolation, was not a predictor of atrial tachyarrhythmia recurrence-free survival. 20 In the present study, the recurrence-free survival rate was similar between patients with and without first-pass isolation on both sides.…”

“… 20 However, Osorio et al also showed that first-pass isolation on both sides, which was generally used as first-pass isolation, was not a predictor of atrial tachyarrhythmia recurrence-free survival. 20 In the present study, the recurrence-free survival rate was similar between patients with and without first-pass isolation on both sides. Wang et al estimated the impact of moderate AI targets (i.e., LA anterior wall 400–450, posterior wall 280–330, and roof/inferior wall 380–430) on the outcomes of PVI in 140 patients with paroxysmal AF and reported low rates of first-pass isolation (49.3%) and excellent recurrence-free survival at the 1-year follow-up (92.1%).…”

“…Osorio et al reported that first-pass isolation on at least one side was an independent predictor of atrial tachyarrhythmia recurrence-free survival after PVI. 20 However, Osorio et al also showed that first-pass persistent AF compared with paroxysmal AF.…”

Very high power very short duration ablation for atrial fibrillation: With great power comes great responsibility

“…FPI is an excellent acute indicator of the quality of RF PVI, and it serves as a reliable surrogate for long‐term success rates 6 . As such it is notable that the reported FPI rates with vHPvSD have been modest, ranging from 18% to 61% 4,5,7 (Table 1).…”

The effect of left atrial wall thickness and pulmonary vein sizes on the acute procedural success of atrial fibrillation ablation

“…We hypothesised that using a novel, modified CLOSE protocol proper isolation of the PVs is achievable even in patients with larger LAWT. First-pass isolation is a valuable marker of PVI's acute procedural success [15,16]. The effects of PV anatomy and LAWT on successful first-pass isolation has not yet been investigated.…”