Optimized lesion size index (o‐LSI): A novel predictor for sufficient ablation of pulmonary vein isolation

Figures

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  FIGURE 1. Flow chart of the study design and outcome. All patients were evaluated in accordance with the exclusion criteria. We evaluated 35 patients and 1417 ablation points and divided them into two groups, with or without insufficient ablation sites. IAS was observed at 25 points/1417 of the total ablation sites. Spontaneous PV reconnection was observed at 16 points, ATP‐provoked dormant PV conduction at 1 point, and the PV‐LA gap site after the initial PVI at 8 points. IAS, insufficient ablation sites; PVI, pulmonary vein isolation; LA, left atrium ATP; adenosine triphosphate disodium hydrate

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  FIGURE 2. The distribution of the IAS across the 16 PV segments on the PVI lines. The black concentric circles indicate spontaneous reconnection, the black circles indicate dormant conduction provoked by adenosine, and the white circles indicate the PV‐LA gap site after the initial PVI. LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RIPV, right superior pulmonary vein; RSPV, right superior pulmonary vein

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  FIGURE 3. A representative PV‐LA bipolar voltage map. The purple areas are defined as high‐voltage areas (>4.00 mV), and the blue, green, yellow, orange, and red areas are low‐voltage areas (<4.00 mV). In this case, an IAS was observed in a relatively high‐voltage area, which was at the superior posterior aspect of the RSPV. IAS, insufficient ablation sites; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RIPV, right superior pulmonary vein; RSPV, right superior pulmonary vein

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  FIGURE 4. The ROC curves for the prediction of IAS are shown in Figure 4. The AUC of the o‐LSI (AUC of 0.742, 95% CI 0.656‐0.827) was better than that of the bipolar voltage (AUC of 0.718, 95% CI 0.632‐0.805). The best cutoff value for predicting IAS was 2.04 for the o‐LSI (88% sensitivity and 55% specificity, P < .0001) and 1.84 for the bipolar voltage (92% sensitivity and 49% specificity, P < .0001). The prognostic performance of the o‐LSI was better than that of the bipolar voltage (P = .043). ROC, receiver operating characteristic; IAS, insufficient ablation sites; AUC, area under the curve; o‐LSI, optimized lesion size index (LSI/bipolar voltage)