The Importance of a Distance between the Lines Encircling Pulmonary Veins in Atrial Fibrillation Ablation on First-Pass Isolation Ratio and Clinical Outcomes

Abstract

Introduction: How wide the encircling line is made may influence the outcomes of pulmonary vein isolation (PVI). In the present study we hypothesised that the distance between the lines encircling the pulmonary veins may correspond with the extent of wide antral circumferential ablation (WACA). The aim of the study was to assess the impact of the distance and the area between the lines on the posterior wall of the left atrium on first-pass isolation rate and 12-month freedom from atrial arrhythmia in patients undergoing PVI ablation. Methods and results: One hundred sixteen patients underwent circumferential ablation index (AI)-guided PVI. The distance between the encircling ablation lines was measured off-line between the uppermost points (right and left) and the lowest points and as the area between the encircling lines on the posterior wall. The first-pass isolation rate and 12-month freedom from atrial arrhythmia were 59% and 73%, respectively. Distance between the encircling lines measured linearly or as the area of the posterior wall, assessed as direct values or indexed to left atrial dimensions, did not differ between patients with and without first-pass isolation or between patients with and without recurrences of atrial arrhythmia. Conclusions: The distance between the ablation lines did not influence the rate of first-pass isolation and arrhythmia recurrence in the long-term follow-up after PVI procedures incorporating the ablation index protocol.

Greater distance between ablation lines reduces the recurrence rate after pulmonary vein isolation

“…In contrast to PVI modifications or adjuncts with no proven efficiency, the accuracy of our suggestion is reflected by results of the AUC analysis showing significant strength of prediction. Interestingly, in a study by Krzyżanowski et al, 18 DBL showed no impact on AF recurrence in the long -term follow -up of first -pass isolation. The contradiction between our findings may arise from methodologic differences.…”

“…Firstly, in the mentioned study, DBL was measured between the uppermost and the lowest points of 2 opposite isolation lines, while in our study it was measured between the nearest points (FIGuRE 5). Moreover, and perhaps more importantly, Krzyżanowski et al 18 did not index the DBL to the total LA diameter. Therefore, in the case of enlarged atria, even with high DBL values, isolation lines might be far from the PVs.…”