Effectiveness and Safety of High-Power Radiofrequency Ablation Guided by Ablation Index for the Treatment of Atrial Fibrillation

Background. To investigate the efficacy and safety of ablation index- (AI-) guided high-power radiofrequency ablation in the treatment of atrial fibrillation (AF). Methods. Outcomes of radiofrequency (RF) applications were compared in a swine ventricular endocardial model ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>n</a:mi> <a:mo>=</a:mo> <a:mn>10</a:mn> </a:math> each for 50 W, 40 W, and 30 W; <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mtext>AI</c:mtext> <c:mo>=</c:mo> <c:mn>500</c:mn> </c:math> ). And a total of 100 consecutive patients with paroxysmal AF undergoing pulmonary vein isolation (PVI) were included. The patients were divided into two groups ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>n</e:mi> <e:mo>=</e:mo> <e:mn>50</e:mn> </e:math> for each) as follows: control group, treated with conventional power (30 W) ablation mode; and study group, treated with high power (40 W) radiofrequency ablation mode. All groups were treated with the same AI value guided the ablation ( <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mtext>target</g:mtext> <g:mtext> </g:mtext> <g:mtext>AI</g:mtext> <g:mo>=</g:mo> <g:mn>400</g:mn> <g:mo>/</g:mo> <g:mn>500</g:mn> </g:math> on posterior/anterior wall, respectively). Acute pulmonary vein (PV) reconnection was assessed post adenosine administration 20 minutes after ablation. Subsequently, pathological observation of porcine heart lesions and necrotic tissue was performed. Additionally, statistical analyses were carried out on patients’ baseline clinical characteristics, surgical data, and total RF energy. Results. In swine ventricular endocardial RF applications, compared with 40 W and 30 W, the use of 50 W was associated with shallower tissue lesion depth ( <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>p</i:mi> <i:mo><</i:mo> <i:mn>0.001</i:mn> </i:math> ) and greater lesion maximum diameter ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>p</k:mi> <k:mo><</k:mo> <k:mn>0.001</k:mn> </k:math> ). Compared with 40 W and 30 W, tissue necrosis caused by 50 W was the deepest and largest ( <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>p</m:mi> <m:mo><</m:mo> <m:mn>0.001</m:mn> </m:math> ). In pulmonary vein isolation (PVI), there was no significant difference in baseline data between the study group and control group ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mi>p</o:mi> <o:mo>></o:mo> <o:mn>0.05</o:mn> </o:math> ). In patients with paroxysmal atrial fibrillation, the procedure time in the high-power group was significantly shortened ( <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>p</q:mi> <q:mo><</q:mo> <q:mn>0.001</q:mn> </q:math> ). The ablation time was significantly shorter ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:mi>p</s:mi> <s:mo><</s:mo> <s:mn>0.001</s:mn> </s:math> ). Compared with control group, RF energy per point and acute pulmonary vein (PV) reconnection were lower ( <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mi>p</u:mi> <u:mo><</u:mo> <u:mn>0.001</u:mn> </u:math> ), and first-pass PVI was higher ( <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mi>p</w:mi> <w:mo><</w:mo> <w:mn>0.01</w:mn> </w:math> ) in study group. There were no significant differences in complications and sinus rhythm maintenance at 12 months between the two groups ( <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mi>p</y:mi> <y:mo>></y:mo> <y:mn>0.05</y:mn> </y:math> ). Conclusions. Compared with conventional (30 W) PVI, AI-guided high-power (40 W) was safe and associated with shorter procedure time and reduced acute PV reconnection.