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Efficacy of the optimal ablation index–targeted strategy for pulmonary vein isolation in patients with atrial fibrillation: the OPTIMUM study results

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Abstract

Purpose

The ablation index (AI) is a recently developed marker for ablation lesion quality that incorporates contact force (CF), time, and power in a weighted formula. There is a paucity of information on whether AI-guided pulmonary vein isolation (PVI) could improve the outcome in patients with atrial fibrillation (AF). We evaluated the optimal AI threshold for avoiding acute pulmonary vein reconnection (PVR), and to compare the efficacy of optimal AI-targeted PVI with that of conventional CF-guided PVI.

Methods

Seventy patients with AF (paroxysmal, 67%) were enrolled. In a phase 1 study, the patients underwent conventional CF-guided PVI (CON group), and the optimal AI threshold for avoiding acute PVR was identified. In phase 2, the patients underwent AI-guided PVI (OAI group). We compared the acute PVR rate between the CON group and the OAI group to demonstrate the efficacy of AI-guided PVI.

Results

In phase 1 (n = 38), acute PVR was observed in 57 of 532 (10.7%) segments. AI values of ≥ 450 at the anterior/roof segments and of ≥ 350 at the posterior/inferior/carina segments were identified as the optimal AI thresholds for avoiding acute PVR. In the phase 2 study targeting those AI values, the OAI group (n = 32) showed a significantly lower acute PVR rate than the CON group (4.2% vs. 10.7%, p < 0.001). The OAI group showed a higher minimum AI and smaller variations in AI values than the CON group.

Conclusions

Optimal AI-targeted PVI is feasible and could improve the acute outcome in patients with AF.

Trial registration

URL: https://www.clinicaltrials.gov. Unique identifier: NCT03389074.

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Acknowledgments

We thank Cho-Rong Jeong, Ji Seon Park, Jiseon Lee, and Junyeop Yeo for their assistance.

Funding

This research was conducted with support from the investigator-initiated study program of Biosense Webster, Inc. (IIS 457).

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Authors and Affiliations

  1. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

    So-Ryoung Lee, Eue-Keun Choi, Eui-Jae Lee, Won-Seok Choe, Myung-Jin Cha & Seil Oh

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Correspondence to Eue-Keun Choi.

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Conflict of interest

SRL, EJL, WSC, MJC, SO declare that they have no conflict of interest. EKC received a research grant from Daiichi-Sankyo, BMS/Pfizer, and Biosense Webster.

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Lee, SR., Choi, EK., Lee, EJ. et al. Efficacy of the optimal ablation index–targeted strategy for pulmonary vein isolation in patients with atrial fibrillation: the OPTIMUM study results. J Interv Card Electrophysiol 55, 171–181 (2019). https://doi.org/10.1007/s10840-019-00565-4

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  • DOI: https://doi.org/10.1007/s10840-019-00565-4

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