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An ablation index operator-independent approach to improve efficacy in atrial fibrillation ablation at 24-month follow-up: a single center experience

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Abstract

Purpose

Since the introduction of catheter ablation as a mainstream treatment for atrial fibrillation (AF), several technical improvements have been put forward. In this contest, Ablation Index (AI) is an accurate ablation quality marker by incorporating power, delivery time, contact force (CF), and catheter stability in a weighted formula. The aim of our study is to evaluate the efficacy of AI-guided AF ablation over 24 month follow-up.

Methods

We evaluated 72 consecutive patients with drug-refractory paroxysmal (66.7%) and early-persistent AF (33.3%) undergoing AI-guided ablation, compared to 72 propensity-matched control patients who underwent CF-guided procedure. All procedures were performed by three skilled operators. Data concerning procedural characteristics and long-term freedom from AF recurrence were analyzed.

Results

At 24-month follow-up, Kaplan-Meier curves of AF recurrence were significantly lower in AI group than in CF group (15.5% vs. 30.6%; p 0.042). These findings were confirmed in a sub analysis regardless of the continued use of antiarrhythmic drugs in the follow-up (42.2% in AI-guided group and 66.7% in CF-guided group, p 0.004). At 24-month follow-up, a positive trend in the decrease of arrhythmia recurrences was observed in AI-guided ablation for all operators.

Conclusions

AI-guided ablation results more effective than CF-guided ablation as demonstrated by a lower incidence of AF recurrences regardless of the use of antiarrhythmic drugs in the follow-up. Each operator seems to improve the long-term success using an AI-guided ablation, thus showing both the efficacy and the reproducibility of this approach.

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Acknowledgments

The authors would like to thank Emanuele Merola, Pasquale De Iuliis, and Beniamino Mazza from Biosense Webster, Inc. for technical support and help with CARTO data extraction. We wish to thank Chiara Crubellati and Paolo Baiardo from Biosense Webster, Inc. for their valuable assistance.

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Authors and Affiliations

  1. Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Via Parea, 4, 20138, Milan, Italy

    Michela Casella, Antonio Dello Russo, Stefania Riva, Valentina Catto, Gabriele Negro, Rita Sicuso, Selene Cellucci, Alessio Gasperetti, Martina Zucchetti, Valentina Ribatti, Viviana Biagioli, Gaetano Fassini & Claudio Tondo

  2. Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY, USA

    Luigi Di Biase

  3. Texas Cardiac Arrhythmia Institute, St Davis Medical Center, Austin, TX, USA

    Luigi Di Biase & Andrea Natale

  4. Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA

    Luigi Di Biase & Andrea Natale

  5. Department of Cardiology, University of Foggia, Foggia, Italy

    Luigi Di Biase

  6. Dell Medical School, University of Texas at Austin, Austin, TX, USA

    Andrea Natale

  7. California Pacific Medical Center, San Francisco, CA, USA

    Andrea Natale

  8. Department of Clinical Science and Community Health, University of Milan, Milan, Italy

    Claudio Tondo

Authors
  1. Michela Casella
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  2. Antonio Dello Russo
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  3. Stefania Riva
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  4. Valentina Catto
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  5. Gabriele Negro
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  6. Rita Sicuso
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  7. Selene Cellucci
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  8. Alessio Gasperetti
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  9. Martina Zucchetti
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  10. Valentina Ribatti
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  11. Viviana Biagioli
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  12. Gaetano Fassini
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  13. Luigi Di Biase
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  14. Andrea Natale
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  15. Claudio Tondo
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Corresponding author

Correspondence to Valentina Catto.

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Conflict of interest

A.D.R. has received consulting fees/honoraria from Biosense Webster. G.F. receives consulting fees/honoraria from Medtronic and Abbott. L.D.B. is a consultant for Biosense Webster, Boston Scientific, Stereotaxis, and Abbott, and has received speaking honoraria from Medtronic, Pfizer, Bristol Meyers, and Biotronik. A.N. is a consultant for Biosense Webster, Abbott, and Janssen, and has received speaking honoraria from Boston Scientific, Biosense Webster, Abbott, Biotronik, and Medtronic. C.T. receives consulting fees/honoraria from Abbott, Medtronic, Boston Scientific, and Biosense Webster, and serves as a 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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Casella, M., Dello Russo, A., Riva, S. et al. An ablation index operator-independent approach to improve efficacy in atrial fibrillation ablation at 24-month follow-up: a single center experience. J Interv Card Electrophysiol 57, 241–249 (2020). https://doi.org/10.1007/s10840-019-00587-y

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  • DOI: https://doi.org/10.1007/s10840-019-00587-y

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