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Ablation index-guided high-power vs. moderate-power cavotricuspid isthmus ablation

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Abstract

Ablation index (AI)-guided ablation is useful for pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) ablation. However, the impact of radiofrequency (RF) application power on CTI ablation with a fixed target AI remains unclear. One-hundred-thirty drug-refractory atrial fibrillation and/or atrial flutter patients who underwent AI-guided CTI ablation with or without PVI between July 2020 and August 2021 were randomly assigned to high-power (45 W) and moderate-power (35 W) groups. We performed CTI ablation with the same target AI value in both groups: 500 for the anterior 1/3 segments and 450 for the posterior 2/3 segments. In total, first-pass conduction block of the CTI was obtained in 111 patients (85.4%), with 7 patients (5.4%) showing CTI reconnection. The rate of first-pass conduction block was significantly higher in the 45 W group (61/65, 93.8%) than in the 35 W group (50/65, 76.9%, P = 0.01). CTI ablation and CTI fluoroscopy time were significantly shorter in the 45 W group than in the 35 W group (CTI ablation time: 192.3 ± 84.8 vs. 319.8 ± 171.4 s, P < 0.0001; CTI fluoroscopy time: 125.2 ± 122.4 vs. 171.2 ± 124.0 s, P = 0.039). Although there was no significant difference, steam pops were identified in two patients from the 45 W group at the anterior segment of the CTI. The 45 W ablation strategy was faster and provided a higher probability of first-pass conduction block than the 35 W ablation strategy for CTI ablation with a fixed AI target.

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Authors and Affiliations

  1. Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan

    Akio Chikata, Kazuo Usuda, Michiro Maruyama & Kanichi Otowa

  2. Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, 920-8641, Japan

    Akio Chikata, Takeshi Kato, Keisuke Usuda, Takashi Kusayama, Toyonobu Tsuda, Kenshi Hayashi & Masayuki Takamura

  3. Department of Pediatrics, Toyama Prefectural Central Hospital, Toyama, Japan

    Shuhei Fujita

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  1. Akio Chikata
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  2. Takeshi Kato
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  3. Kazuo Usuda
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  4. Shuhei Fujita
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Correspondence to Takeshi Kato.

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Chikata, A., Kato, T., Usuda, K. et al. Ablation index-guided high-power vs. moderate-power cavotricuspid isthmus ablation. Heart Vessels 38, 90–95 (2023). https://doi.org/10.1007/s00380-022-02125-9

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