Why the study?
It remains unclear whether recommended ablation index values are suitable for individualized catheter ablation, prompting exploration of their relationship with values when unipolar electrograms indicate transmural lesion formation.
Does unipolar electrogram modification occur at lower ablation index values than currently recommended during pulmonary vein isolation in patients with paroxysmal atrial fibrillation?
Does unipolar electrogram modification occur at lower ablation index values than currently recommended during pulmonary vein isolation in patients with paroxysmal atrial fibrillation?
Unipolar electrogram modification suggests that transmural lesions are achieved at lower ablation index values than currently recommended, particularly in the posterior and inferior pulmonary vein walls, indicating potential for reducing unnecessary radiofrequency energy delivery.
May indicate transmural lesions at lower AI than recommended in PVI; hypothesis-generating for reduced energy delivery, requiring prospective validation.
Background It remains unclear whether the current recommended ablation index (AI) value is suitable for individualized catheter ablation. Prior research has established that the elimination of the negative component of the unipolar electrogram (UP-EGM) applications reflects the formation of transmural lesion during radiofrequency ablation. The aim of this study was to explore the relationship between AI values when UP-EGM turns positive during pulmonary vein isolation and recommended AI values. Methods A total of 50 patients with drug-refractory PAF who underwent index RFCA were consecutively included from September 2022 to January 2023. All the patients underwent AI-guided ablation. UP-EGM was also recorded during the procedure. The difference in the AI between the value when the UP-EGM turned completely positive [AI UP-EGM(+) ] and the recommended value at the end of ablation (AI END ) was compared. Results A total of 2 954 lesion points were detected in 50 patients. The average values of AI UP-EGM(+) at the anterior wall and the posterior wall were 420.9 and 267.4, respectively. The average AI END values were 524.3 and 393.9 at the anterior wall and the posterior wall, respectively. The percentage of increase in the AI between the AI UP-EGM(+) and AI END groups was 22%, 28% at the anterior wall and 47%, 49% at the posterior wall ( P < 0.001). After a mean follow-up duration of 11.30 ± 2.10 months, 44 patients (88%) remained in sinus rhythm without antiarrhythmic drugs. Conclusion The AI UP-EGM(+) was lower than the recommended value for all the pulmonary vein regions. The recommended AI value seems to be too high for the posterior and inferior walls, but this remains to be proven in future research.
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Sun et al. (2024) studied this question.
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