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Higher than recommended lesion size index target values for pulmonary vein isolation result in better clinical outcomes in paroxysmal atrial fibrillation patients

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Abstract

Purpose

Catheter ablation is a cornerstone of the therapy for paroxysmal atrial fibrillation. The importance of effective lesion size formation during pulmonary vein isolation is gauged through conduction recovery and recurrence of arrhythmia. Therefore, the lesion size index (LSI) is designed to utilize traditional intraprocedural parameters and predict procedural success. The impact of the optimal LSI index and the respective segments of the pulmonary veins has not been commonly evaluated. We aimed to assess whether higher and targeted LSI on the different segments of pulmonary veins could actually lead to better clinical outcomes of paroxysmal atrial fibrillation ablation.

Methods

Retrospective analyses of drug-refractory paroxysmal atrial fibrillation patients who underwent first catheter ablation were conducted. Targeted LSI of 6.5 at the anterior wall and 5.2 at the posterior wall, roof, and floor of the pulmonary vein was applied. The primary endpoint was defined as arrhythmias recurrence assessed by routine electrocardiograms and 24-h ambulatory electrocardiographic monitoring at 3, 6, and 12 months post-ablation.

Results

Among the included 39 patients, the single-procedure 12-month freedom from arrhythmias was reached in 92.3% of patients. Interestingly, there was no tendency towards an increased number of adverse effects using a higher LSI index.

Conclusions

Atrial fibrillation ablation guided by targeted LSI value showed efficiency on the freedom from arrhythmias during 1-year follow-up period without harmful effects.

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Data availability

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Authors and Affiliations

  1. Clinic for Heart and Cardiovascular Diseases, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia

    Josip Katić, Ante Anić, Toni Brešković & Zrinka Jurišić

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  1. Josip Katić
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  2. Ante Anić
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  3. Toni Brešković
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  4. Zrinka Jurišić
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Contributions

Zrinka Jurišić and Ante Anić contributed to the conception and design of the study. Josip Katic screened the articles and assessed the quality of the studies and performed the data extraction and analysis. Josip Katić and Toni Brešković drafted the manuscript, and Ante Anić and Zrinka Jurišić revised the manuscript critically for important intellectual content. All of the authors contributed to the interpretation of the data, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.

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Correspondence to Josip Katić.

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Katić, J., Anić, A., Brešković, T. et al. Higher than recommended lesion size index target values for pulmonary vein isolation result in better clinical outcomes in paroxysmal atrial fibrillation patients. J Interv Card Electrophysiol 64, 463–468 (2022). https://doi.org/10.1007/s10840-021-01053-4

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