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Lesion index: a novel guide in the path of successful pulmonary vein isolation

  • Antonio Dello Russo
  • Gaetano M. Fassini
  • Michela Casella
  • Elena Romanelli
  • Salvatore Pala
  • Stefania Riva
  • Valentina Catto
  • Massimo Moltrasio
  • Fabrizio Tundo
  • Martina Zucchetti
  • Benedetta Majocchi
  • Maria Antonietta Dessanai
  • Francesca Pizzamiglio
  • Giulia Vettor
  • Valentina Ribatti
  • Alessio Gasperetti
  • Selene Cellucci
  • Gabriele Negro
  • Rita Sicuso
  • Corrado Carbucicchio
  • Claudio Tondo
Article
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Abstract

Purpose

Previous studies indicate force time integral (FTI) as a radiofrequency (RF) lesion quality marker, while not considering power supply. Tacticath™ Quartz catheter provides Lesion index (LSI), a lesion quality marker derived by contact force (CF), power supply, and RF time combined. Our aim is to assess LSI and FTI correlation and a LSI-related cutoff of atrial fibrillation (AF) recurrences 12 months after pulmonary vein isolation (PVI).

Methods

We retrospectively enrolled 37 patients who underwent RF ablation using Tacticath™ Quartz catheter. AF recurrence rate was evaluated 3, 6, and 12 months after PVI procedure.

Results

AF recurrence was detected in 32% of patients. FTI mean value was significantly lower in left superior pulmonary vein (LSPV: 256 ± 86 gs vs 329 ± 117 gs, p = 0.05) and right inferior pulmonary vein (RIPV: 253 ± 128 gs vs 394 ± 123 gs p = 0.006) in patients with AF recurrences; no significant differences were found in right superior pulmonary vein (RSPV) and left inferior pulmonary vein (LIPV). LSI instead was significantly higher for all veins in patients without AF recurrences: LSPV (5.2 ± 0.7 vs 4.6 ± 0.8, p = 0.03), LIPV (5.0 ± 0.8 vs 4.5 ± 0.6, p = 0.04), RSPV (5.5 ± 0.6 vs 5.1 ± 0.6, p = 0.05), and RIPV (5.5 ± 0.7 vs 4.7 ± 0.8, p = 0.006). Receiver operator characteristic curve suggests 5.3 as LSI overall cutoff value predicting freedom from disease at 1-year follow-up.

Conclusions

Our preliminary data suggest that a LSI mean value higher than 5.3 can be considered a good predictor of AF freedom at 1-year follow-up.

Keywords

Atrial fibrillation Catheter ablation Contact force Force time integral Lesion index Predictive lesion index 

Notes

Acknowledgments

The authors acknowledge Viviana Biagioli (Scientific Secretary of the Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milano, Italy) for editorial assistance.

Compliance with ethical standards

Conflict of interest

Elena Romanelli is employee of Abbott, Sesto San Giovanni, Italy. Salvatore Pala received consulting fees from Abbott Medical Italy. Dr. Antonio Dello Russo received consulting fees/honoraria from Biosense Webster. Dr. Gaetano Fassini, Dr. Massimo Moltrasio, and Dr. Fabrizio Tundo received consulting fees/honoraria from Medtronic. Prof. Claudio Tondo received consulting fees/honoraria from Abbott, Medtronic, Boston Scientific, and Biosense Webster. He serves as member of EU Medtronic Advisory Board and Boston Scientific Advisory Board. The other authors declare no relationships with industry.

Ethical approval

The study was approved by the Institutional Review Board of Centro Cardiologico Monzino IRCCS.

Informed consent

Patients were provided informed consent.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Antonio Dello Russo
    • 1
  • Gaetano M. Fassini
    • 1
  • Michela Casella
    • 1
  • Elena Romanelli
    • 2
  • Salvatore Pala
    • 1
  • Stefania Riva
    • 1
  • Valentina Catto
    • 1
  • Massimo Moltrasio
    • 1
  • Fabrizio Tundo
    • 1
  • Martina Zucchetti
    • 1
  • Benedetta Majocchi
    • 1
  • Maria Antonietta Dessanai
    • 1
  • Francesca Pizzamiglio
    • 1
  • Giulia Vettor
    • 1
  • Valentina Ribatti
    • 1
  • Alessio Gasperetti
    • 1
  • Selene Cellucci
    • 1
  • Gabriele Negro
    • 1
  • Rita Sicuso
    • 1
  • Corrado Carbucicchio
    • 1
  • Claudio Tondo
    • 1
    • 3
  1. 1.Heart Rhythm CenterCentro Cardiologico Monzino IRCCSMilanItaly
  2. 2.Abbott MedicalSesto San GiovanniItaly
  3. 3.Dipartimento di Scienze Cliniche e di ComunitàUniversità degli Studi di MilanoMilanItaly

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