The industrialization of ablation: a highly standardized and reproducible workflow for radiofrequency ablation of atrial fibrillation

Tom De Potter; Tina D. Hunter; Lee Ming Boo; Sofia Chatzikyriakou; Teresa Strisciuglio; Etelvino Silva; Peter Geelen

doi:10.1007/s10840-019-00622-y

October 17, 2019Journal of Interventional Cardiac ElectrophysiologyOpen Access

The industrialization of ablation: a highly standardized and reproducible workflow for radiofrequency ablation of atrial fibrillation

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Why the study?

The study was conducted to report the efficacy of a standardized workflow for AF ablation using advances such as 3D imaging and contact force sensing in a real-world setting.

Does a standardized workflow for AF ablation using contact force sensing and ablation index improve procedural efficiency and freedom from atrial arrhythmia recurrence in patients with paroxysmal or persistent AF?

Structured PICO

Does a standardized workflow for AF ablation using contact force sensing and ablation index improve procedural efficiency and freedom from atrial arrhythmia recurrence in patients with paroxysmal or persistent AF?

P

Population

787 patients (605 with paroxysmal AF and 182 with persistent AF) undergoing consecutive AF ablations from 2014 to 2015 at a high-volume site in Belgium.

I

Intervention

Standardized workflow for radiofrequency ablation of atrial fibrillation including 3D modeling and encircling of pulmonary veins using a THERMOCOOL SMARTTOUCH Catheter guided by CARTO VISITAG Module and ablation index.

O

Outcome

Freedom from atrial arrhythmia recurrencehard clinical

A standardized workflow for AF ablation utilizing contact force sensing and ablation index results in short procedure times, minimal fluoroscopy, and high rates of freedom from arrhythmia recurrence.

Implication

Supports differential success by AF type with this workflow; hypothesis-generating and requires randomized confirmation before guiding practice.

Abstract

Background or Purpose The purpose of this analysis was to report on efficacy of a standardized workflow for atrial fibrillation (AF) ablation using technology advances such as 3D imaging and contact force sensing in a real-world setting. Methods Consecutive AF ablations from 2014 to 2015 at a high-volume site in Belgium were included. The workflow consisted of a pre-specified procedure sequence including 3D modeling followed by radiofrequency encircling of the pulmonary veins (25 W posterior wall, 35 W anterior wall) with a THERMOCOOL SMARTTOUCH® Catheter guided by CARTO VISITAG™ Module (2.5 mm/5 s stability, 50% > 7 g) and ablation index (targets: 550 anterior wall, 400 posterior wall). Efficiency endpoints were procedure time, fluoroscopy time, and radiation dose. The primary effectiveness endpoint was freedom from atrial arrhythmia recurrence. Results A total of 605 paroxysmal AF (PAF) and 182 persistent AF (PsAF) patients were followed for 436 ± 199 days. Mean procedure times were short (PAF: 96.1 ± 26.2 min; PsAF: 109.2 ± 35.6 min) with most procedures (90.6% PAF; 81.3% PsAF) completed in ≤ 120 min. Minimal fluoroscopy was utilized (PAF: 6.1 ± 3.8 min, 5.9 ± 3.4 Gy*cm 2 ; PsAF: 6.9 ± 4.7 min, 7.4 ± 4.9 Gy*cm 2 ). Freedom from atrial arrhythmia recurrence was higher for PAF than PsAF patients (OR: 2.0, 95% CI: 1.4–2.9, p = 0.0003), but adjusted mean rates were high in both groups (81.0% vs. 67.9%). Rates were adjusted for prior ablation and age (at 65 years). Conclusion AF ablation using a standardized workflow resulted in low procedure times and variability, with minimal fluoroscopy exposure. Long-term freedom from atrial arrhythmia recurrence was high in both PAF and PsAF populations.