Optimal Ablation Index Parameters for Radiofrequency Ablation Therapy of Atrial Fibrillation

Overview

Journal Pak J Med Sci

Specialty General Medicine

Date 2022 Apr 28

PMID 35480525

Authors

Xiaoru Qin

Xiaofei Jiang

Qiyan Yuan

Guangli Xu

Xianzhi He

Affiliations

Soon will be listed here.

Abstract

Objectives: To explore the optimal ablation index (AI) parameters for radiofrequency catheter ablation (RA) for treating atrial fibrillation (AF).

Methods: Patients with AF (186) who underwent bilateral PVAI in the Department of Cardiology, Zhuhai People's Hospital, Guangdong Province, from March 2018 to October 2019 and received catheter ablation as first-round treatment, were grouped according to the received AI. Control group included patients (95) who received the recommended AI ablation (350-400 for posterior wall, 400-450 for non-posterior wall). Patients in optimal AI group were ablated with optimal AI (300-330 for posterior wall, 350-380 for non-posterior wall). Recurrence was defined as any AF, atrial tachycardia, or atrial flutter lasting more than 30 seconds without anti-arrhythmic drugs after the 3-month blank period.

Results: Of 186 patients, 66 patients had paroxysmal atrial fibrillation and a mean CHADS-VASc score of 2.83±1.64. Isolation rates of bilateral PVI in both groups were 91.4% and 93.6%, for patients with paroxysmal atrial fibrillation, and 81.7% and 80% for patients with persistent atrial fibrillation (P > 0.05). Left atrial function index (LAFI) decreased under the condition of sinus rhythm at the 3rd and 6th months (P < 0.05). LAFI improvement was significantly better in the optimal AI group than in the control group (P < 0.05). Rates of pain and cough during the ablation, and postoperative gastrointestinal discomfort and use of PPIs were higher in the control group (P < 0.05). The recurrence rate was 14.7% and 14.3% after 12 months of follow-up, respectively, and the difference was not statistically significant (P > 0.05).

Conclusion: Radiofrequency ablation of AF, guided by optimal AI combined with impedance, can minimize atrial injury, prevent atrial failure, promote the recovery of atrial function, reduces intraoperative cough, pain, and postoperative gastrointestinal discomfort and use of PPIs.

References

Bertaglia E, Fassini G, Anselmino M, Stabile G, Grandinetti G, Simone A . Comparison of ThermoCool® Surround Flow catheter versus ThermoCool® catheter in achieving persistent electrical isolation of pulmonary veins: a pilot study. J Cardiovasc Electrophysiol. 2012; 24(3):269-73. DOI: 10.1111/jce.12031. View

Beinart R, Abbara S, Blum A, Ferencik M, Heist K, Ruskin J . Left atrial wall thickness variability measured by CT scans in patients undergoing pulmonary vein isolation. J Cardiovasc Electrophysiol. 2011; 22(11):1232-6. DOI: 10.1111/j.1540-8167.2011.02100.x. View

Ullah W, McLean A, Tayebjee M, Gupta D, Ginks M, Haywood G . Randomized trial comparing pulmonary vein isolation using the SmartTouch catheter with or without real-time contact force data. Heart Rhythm. 2016; 13(9):1761-7. DOI: 10.1016/j.hrthm.2016.05.011. View

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B . 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38):2893-2962. DOI: 10.1093/eurheartj/ehw210. View

Avitall B, Mughal K, Hare J, Helms R, Krum D . The effects of electrode-tissue contact on radiofrequency lesion generation. Pacing Clin Electrophysiol. 1998; 20(12 Pt 1):2899-910. DOI: 10.1111/j.1540-8159.1997.tb05458.x. View

Ullah W, Hunter R, Finlay M, McLean A, Dhinoja M, Sporton S . Ablation Index and Surround Flow Catheter Irrigation: Impedance-Based Appraisal in Clinical Ablation. JACC Clin Electrophysiol. 2018; 3(10):1080-1088. DOI: 10.1016/j.jacep.2017.03.011. View

Bisbal F, Baranchuk A, Braunwald E, Bayes de Luna A, Bayes-Genis A . Atrial Failure as a Clinical Entity: JACC Review Topic of the Week. J Am Coll Cardiol. 2020; 75(2):222-232. DOI: 10.1016/j.jacc.2019.11.013. View

Thijs V, Brachmann J, Morillo C, Passman R, Sanna T, Bernstein R . Predictors for atrial fibrillation detection after cryptogenic stroke: Results from CRYSTAL AF. Neurology. 2015; 86(3):261-9. PMC: 4733152. DOI: 10.1212/WNL.0000000000002282. View

Wittkampf F, van Oosterhout M, Loh P, Derksen R, Vonken E, Slootweg P . Where to draw the mitral isthmus line in catheter ablation of atrial fibrillation: histological analysis. Eur Heart J. 2005; 26(7):689-95. DOI: 10.1093/eurheartj/ehi095. View

10.

Berte B, Hilfiker G, Russi I, Moccetti F, Cuculi F, Toggweiler S . Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter. J Cardiovasc Electrophysiol. 2019; 30(11):2199-2204. DOI: 10.1111/jce.14122. View

11.

Phlips T, Taghji P, El Haddad M, Wolf M, Knecht S, Vandekerckhove Y . 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. Europace. 2018; 20(FI_3):f419-f427. DOI: 10.1093/europace/eux376. View

12.

Itoh T, Kimura M, Tomita H, Sasaki S, Owada S, Horiuchi D . Reduced residual conduction gaps and favourable outcome in contact force-guided circumferential pulmonary vein isolation. Europace. 2015; 18(4):531-7. PMC: 4865059. DOI: 10.1093/europace/euv206. View

13.

Calkins H, Hindricks G, Cappato R, Kim Y, Saad E, Aguinaga L . 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. Europace. 2017; 20(1):157-208. PMC: 5892164. DOI: 10.1093/europace/eux275. View

14.

Hussein A, Das M, Chaturvedi V, Asfour I, Daryanani N, Morgan M . Prospective use of Ablation Index targets improves clinical outcomes following ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2017; 28(9):1037-1047. DOI: 10.1111/jce.13281. View

15.

Nakamura K, Naito S, Sasaki T, Nakano M, Minami K, Nakatani Y . Randomized comparison of contact force-guided versus conventional circumferential pulmonary vein isolation of atrial fibrillation: prevalence, characteristics, and predictors of electrical reconnections and clinical outcomes. J Interv Card Electrophysiol. 2015; 44(3):235-45. DOI: 10.1007/s10840-015-0056-7. View

16.

Thiagalingam A, dAvila A, Foley L, Guerrero J, Lambert H, Leo G . Importance of catheter contact force during irrigated radiofrequency ablation: evaluation in a porcine ex vivo model using a force-sensing catheter. J Cardiovasc Electrophysiol. 2010; 21(7):806-11. DOI: 10.1111/j.1540-8167.2009.01693.x. View

17.

Cummings J, Schweikert R, Saliba W, Burkhardt J, Kilikaslan F, Saad E . Brief communication: atrial-esophageal fistulas after radiofrequency ablation. Ann Intern Med. 2006; 144(8):572-4. DOI: 10.7326/0003-4819-144-8-200604180-00007. View

18.

Das M, Loveday J, Wynn G, Gomes S, Saeed Y, Bonnett L . Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. Europace. 2016; 19(5):775-783. DOI: 10.1093/europace/euw105. View

19.

Lee S, Choi E, Lee E, Choe W, Cha M, Oh S . Efficacy of the optimal ablation index-targeted strategy for pulmonary vein isolation in patients with atrial fibrillation: the OPTIMUM study results. J Interv Card Electrophysiol. 2019; 55(2):171-181. DOI: 10.1007/s10840-019-00565-4. View

20.

Chinitz L, Melby D, Marchlinski F, Delaughter C, Fishel R, Monir G . Safety and efficiency of porous-tip contact-force catheter for drug-refractory symptomatic paroxysmal atrial fibrillation ablation: results from the SMART SF trial. Europace. 2017; 20(FI_3):f392-f400. DOI: 10.1093/europace/eux264. View