What question did this study set out to answer?

May 31, 2016EP EuropaceOpen Access

Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values

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Why the study?

Does Ablation Index predict pulmonary vein reconnection at 2-month repeat electrophysiology study in patients with paroxysmal atrial fibrillation undergoing PVI?

Population

40 patients with paroxysmal atrial fibrillation undergoing contact force-guided pulmonary vein isolation (PVI)

Design

Cohort

Follow-up

2 months

Authors

MDMoloy DasFreeman Hospital JLJonathan J. LovedayUniversity of Liverpool GWGareth WynnThe Royal Melbourne Hospital

Discussion

Member takes

Implication

Supports AI thresholds to reduce PV reconnection risk; hypothesis-generating pending randomized confirmation of targets.

Key Points

Compare the ablation index with force-time integral for predicting pulmonary vein reconnection at repeat electrophysiology study and establish regional lesion threshold targets.
Assessed 40 patients with paroxysmal atrial fibrillation who underwent contact force-guided pulmonary vein isolation evaluated across a 12-segment model.
Performed a repeat electrophysiology study at 2 months in all patients, regardless of symptoms, to identify anatomical sites of pulmonary vein reconnection.
Late pulmonary vein reconnection occurred in 53 segments (11%) across 25 patients (62%), with reconnected segments demonstrating significantly lower minimum ablation index [308 (252-336) vs. 373 (323-423), P < 0.0001] and force-time integral [137 (92-182) vs. 228 (157-334), P < 0.0001].
Anterior and roof segments required significantly higher minimum ablation index values than posterior and inferior segments to prevent reconnection (P < 0.0001).
Zero reconnection occurred in segments that achieved a minimum ablation index of ≥370 in posterior/inferior segments and ≥480 in anterior/roof segments.

Structured PICO

Does Ablation Index predict pulmonary vein reconnection at 2-month repeat electrophysiology study in patients with paroxysmal atrial fibrillation undergoing PVI?

Population

40 patients with paroxysmal atrial fibrillation undergoing contact force-guided pulmonary vein isolation (PVI)

Intervention

Contact force-guided pulmonary vein isolation evaluated using Ablation Index (AI) and Force-Time Integral (FTI) in a 12-segment model

Outcome

Pulmonary vein reconnection at repeat electrophysiology study at 2 monthssurrogate

Ablation Index is a strong predictor of pulmonary vein reconnection, with specific regional target values (≥370 for posterior/inferior, ≥480 for anterior/roof) required to prevent reconnection.

Cite This Study

Das et al. (2016) studied this question.

synapsesocial.com/papers/6a0ff1268090e499da606402 https://doi.org/10.1093/europace/euw105

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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