Safety and efficacy of atrial fibrillation ablation guided by Ablation Index module
Reconnection of pulmonary veins (PVs) remains common following radiofrequency catheter ablation for atrial fibrillation (AF). Ablation Index (AI) is a novel ablation quality marker that incorporates stability, contact force (CF), time, and power in a weighted formula. Its use seems to improve lesion durability. This is a prospective, single-arm registry to investigate on the safety and mid-term efficacy of AF ablation guided by the AI.
One hundred fifty-six consecutive patients (mean age 58 ± 10 years, 49% males, 44% with structural heart disease) referred for paroxysmal (124) or persistent (32) AF underwent antral PV isolation using a surround flow CF-sensing catheter guided by the AI. Radiofrequency was delivered targeting interlesion distance ≤ 6 mm and Ablation Index of 330–350 at posterior wall and 400–450 at anterior wall.
Mean overall procedure time was 95 ± 30 min with a mean fluoroscopy time of 5 ± 6 min. Mean ablation time was 26 ± 10 min, 627/628 targeted PV were isolated. One pericardial effusion and two groin hematomas were reported; none required intervention. During a mean follow-up of 14 ± 6 months, 17 (10.8%) (9% paroxysmal AF vs 22% persistent AF, p = 0.09) patients had an atrial arrhythmia recurrence.
PV ablation guided by AI resulted feasible, achieving a high rate of isolated PVs, with a low complication rate, and allowed a high single-procedure arrhythmia-free survival at 14 months.
KeywordsAtrial fibrillation Catheter ablation Contact force Ablation Index Safety Mid-term outcome
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
The study was approved by the institutional review committees, and all patients signed informed consents.
- 4.Neuzil P, Reddy VY, Kautzner J, Petru J, Wichterle D, Shah D, et al. Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circ Arrhythm Electrophysiol. 2013;6:327–33. https://doi.org/10.1161/CIRCEP.113.000374.CrossRefGoogle Scholar
- 5.Jiang RH, Po SS, Tung R, Liu Q, Sheng X, Zhang ZW, et al. Incidence of pulmonary vein conduction recovery in patients without clinical recurrence after of paroxysmal atrial fibrillation: mechanistic implications. Heart Rhythm. 2014;11:969–76. https://doi.org/10.1016/j.hrthm.2014.03.015.CrossRefGoogle Scholar
- 6.Nakagawa H, Ikeda A, Constantine G, Govari A, Sharma T, Pitha JV, et al. Controlling lesion size and incidence of steam pop by controlling contact force, radiofrequency power and application time (Force-Power-Time Index) in canine beating heart. [Abstract] Heart Rhythm. 2012;9:S5.Google Scholar
- 7.Nakagawa H, Ikeda A, Govari A, Papaioannou T, Costantine G, Bar-Tal M, et al. Prospective study to test the ability to create RF lesion at predicted depth and diameter using a new formula incorporating contact force, radiofrequency power and application time (force-power-time index) in beating heart. [Abstract] Heart Rhythm. 2014;11(Suppl):S548.Google Scholar
- 8.Das M, Loveday JJ, Wynn GJ, Gomes S, Saeed Y, Bonnett LJ, et al. 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. 2017;19:775–83. https://doi.org/10.1093/europace/euw105.Google Scholar
- 9.Ullah W, Hunter RJ, Finlay MC, McLean A, Dhinoja MB, Sporton S, et al. Ablation index and surround flow catheter irrigation impedance-based appraisal in clinical ablation. J Am Coll Cardiol EP. 2017; https://doi.org/10.1016/j.jacep.2017.03.011.
- 11.Taghij P, El Haddad M, Philips T, Wolf M, Knecht S, Vandekerckhove Y, et al. Evaluation of a strategy aiming to enclose the pulmonary vein with contiguous and optimized radiofrequency lesion in paroxysmal atrial fibrillation. J Am Coll Cardiol EP. 2017; https://doi.org/10.1016/j.jacep.2017.06.023.
- 12.Stabile G, Di Donna P, Schillaci V, Di Monaco A, Iuliano A, Caponi D, et al. Safety and efficacy of pulmonary vein isolation using a surround flow catheter with contact force measurement capabilities: a multicenter registry. J Cardiovasc Electrophysiol. 2017;28:762–7. https://doi.org/10.1111/jce.13227.CrossRefGoogle Scholar
- 13.Stabile G, Scaglione M, Del Greco M, De Ponti R, Bongiorni MG, Zoppo F, et al. Reduced fluoroscopy exposure during ablation of atrial fibrillation using a novel electroanatomical navigation system: a multicentre experience. Europace. 2012;14:60–5. https://doi.org/10.1093/europace/eur271.CrossRefGoogle Scholar
- 14.Bertaglia E, Fassini G, Anselmino M, Stabile G, Grandinetti G, Simone AD, et al. Comparison of ThermoCool(®) Surround Flow catheter versus ThermoCool(®) catheter in achieving persistent electrical isolation of pulmonary veins: a pilot study. J Cardiovasc Electrophysiol. 2013;24:269–73. https://doi.org/10.1111/jce.12031.CrossRefGoogle Scholar
- 16.Reddy VY, Shah D, Kautzner J, Schmidt B, Saoudi N, Herrera C, et al. The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm. 2012;9:1789–95. https://doi.org/10.1016/j.hrthm.2012.07.016.CrossRefGoogle Scholar
- 17.Sciarra L, Golia P, Natalizia A, De Ruvo E, Dottori S, Scarà A, et al. Which is the best catheter to perform atrial fibrillation ablation? A comparison between standard ThermoCool, SmartTouch, and Surround Flow catheters. J Interv Card Electrophysiol. 2014;39:193–200. https://doi.org/10.1007/s10840-014-9874-2.Google Scholar
- 18.Marijon E, Fazaa S, Narayanan K, Guy-Moyat B, Bouzeman A, Providencia R, et al. Real-time contact force sensing for pulmonary vein isolation in the setting of paroxysmal atrial fibrillation: procedural and 1-year results. J Cardiovasc Electrophysiol. 2014;25:130–7. https://doi.org/10.1111/jce.12303.CrossRefGoogle Scholar
- 20.Sigmund E, Puererfellner H, Derndorfer M, Kollias G, Winter S, Aichinger J, et al. Optimizing radiofrequency ablation of paroxysmal and persistent atrial fibrillation by direct catheter force measurement-a case-matched comparison in 198 patients. Pacing Clin Electrophysiol. 2015;38:201–8. https://doi.org/10.1111/pace.12549.CrossRefGoogle Scholar
- 21.Lee G, Hunter RJ, Lovell MJ, Finlay M, Ullah W, Baker V, et al. Use of contact force-sensing ablation catheter with advanced catheter location significantly reduced fluoroscopy time and radiation dose in catheter ablation of atrial fibrillation. Europace. 2016;18:211–8. https://doi.org/10.1093/europace/euv186.CrossRefGoogle Scholar
- 23.Zucchelli G, Sirico G, Rebellato L, Marini M, Stabile G, Del Greco M, et al. Contiguity between ablation lesions and strict catheter stability settings assessed by VISITAG™ module improve clinical outcome of paroxysmal atrial fibrillation ablation. Results from the VISITALY Study. Circ J. 2018;82:974–82.CrossRefGoogle Scholar