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Ablation index–guided pulmonary vein isolation can reduce early recurrences of atrial tachyarrhythmias: a propensity score–matched analysis

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Early recurrence of atrial tachyarrhythmias (ERAT) cause various symptoms and predict worse outcomes after pulmonary vein isolation (PVI). This study aimed to clarify whether ablation index (AI)–guided PVI, which is a novel technology of radiofrequency ablation, could reduce ERAT as compared to conventional contact force (CF)–guided PVI.

Methods

Consecutive atrial fibrillation (AF) patients who underwent initial PVI from September 2014 to August 2019 were enrolled. We divided the patients into two groups: patients who underwent AI-guided PVI (AI group) and those who underwent CF-guided PVI (CF group). Using propensity score matching (PSM), we adjusted for the patient backgrounds. We compared the incidence of ERAT and late reconnection rate of isolated pulmonary veins (PVs) during second session between the two groups. ERAT was defined as any atrial tachyarrhythmias ≥ 30 s during a 90-day blanking period.

Results

A total of 697 AF patients (paroxysmal 51%) were enrolled. After the PSM, both groups included 229 patients. The incidence of ERAT was significantly lower in the AI group than that in the CF group (21.5% vs. 36.1%, P < 0.001). Total 118 patients (25.7%) experienced late recurrence of atrial tachyarrhythmias (LRAT) after blanking period. LRAT free survival rate was significantly higher in patients without ERAT than those with ERAT (88.1% vs. 42.0%, P < 0.001). The rate of PV reconnection was lower in the AI group than that in the CF group (45.8% vs. 71.4%, P = 0.028). Multivariate analysis demonstrated that AI-guided PVI was independently correlated with ERAT (OR = 0.415, 95%CI = 0.269–0.639, P < 0.001).

Conclusions

AI-guided PVI can reduce ERAT as compared to conventional CF-guided PVI.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Acknowledgements

We thank the clinical engineers in Osaka Rosai Hospital for their technical assistance during the electrophysiological study and John Martin for his linguistic assistance.

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Authors and Affiliations

  1. Department of Cardiology, Osaka Rosai Hospital, Nagasonecho, kita-ku, Sakai, Osaka, 3-1179, Japan

    Koji Yasumoto, Yasuyuki Egami, Kohei Ukita, Akito Kawamura, Hitoshi Nakamura, Yutaka Matsuhiro, Masaki Tsuda, Naotaka Okamoto, Akihiro Tanaka, Yasuharu Matsunaga-Lee, Masamichi Yano, Ryu Shutta, Masami Nishino & Jun Tanouchi

  2. Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Yasushi Sakata

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  1. Koji Yasumoto
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Correspondence to Masami Nishino.

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Ethics approval

This study was approved by the local ethics committee (approved number: 2020–29).

Informed consent

All patients provided their informed consent for the CA procedure.

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The authors declare no competing interests.

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Yasumoto, K., Egami, Y., Ukita, K. et al. Ablation index–guided pulmonary vein isolation can reduce early recurrences of atrial tachyarrhythmias: a propensity score–matched analysis. J Interv Card Electrophysiol 64, 479–487 (2022). https://doi.org/10.1007/s10840-021-01059-y

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  • DOI: https://doi.org/10.1007/s10840-021-01059-y

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