Key result
Pulmonary vein isolation using ablation index and an interlesion distance of <5 mm significantly increased arrhythmia-free survival to 86% compared to 72% with contact force-guided ablation.
Why the study?
Single procedure success rates of durable PVI for PAF vary, and the impact of combining ablation index with stringent lesion contiguity needed evaluation.
Does pulmonary vein isolation using ablation index and an interlesion distance <5 mm improve freedom from atrial tachyarrhythmia in patients with paroxysmal atrial fibrillation compared to contact force-guided drag-and-ablate technique?
Observational (n=100)
No
Does pulmonary vein isolation using ablation index and an interlesion distance <5 mm improve freedom from atrial tachyarrhythmia in patients with paroxysmal atrial fibrillation compared to contact force-guided drag-and-ablate technique?
Absolute Event Rate: 86% vs 72%
p-value: p=0.047
Pulmonary vein isolation using ablation index and an interlesion distance of <5 mm significantly improves arrhythmia-free survival and reduces procedure time compared to standard contact force-guided ablation in patients with paroxysmal atrial fibrillation.
May support AI-guided PVI with ILD <5 mm in paroxysmal AF; hypothesis-generating, requiring randomized confirmation before practice change.
BACKGROUND: The single procedure success rates of durable pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF) varies between 80 and 90%. Ablation index, incorporating contact force, stability, time and power is a more profound parameter of significant lesion size and has been established. Equally important is a stringent contiguity of the lesion set. METHODS AND RESULTS: A total number of 100 consecutive patients undergoing de-novo catheter ablation for paroxysmal atrial fibrillation (PAF) were analyzed between 2016 and 2019. In the first 50 patients (group A) PVI was performed using a surround flow, contact force catheter (Biosense Webster Thermocool STSF, Biosense Webster, USA) with a drag-and-ablate technique to encircle the PVs. In the following 50 patients (group B), PVI was performed using ablation index and a stringent lesion contiguity with an interlesion distance (ILD) of <5 mm. The baseline characteristics showed no significant differences between both groups. During a mean follow-up of 18 ± 3 months after a single procedure, 36 (72%) patients of group A were free of arrhythmia recurrence versus 43 (86%) patients in group B (p = 0.047). A total of 14 patients (group A: 10 (20%), group B: 4 (8%); underwent a redo-procedure. 7 patients of group A (14%) and 2 patients of group B (4%) showed recovered veins. In 3 patients of group A and 2 patients of group B the PVs were durably isolated. In these patients persistent AF recurrence was caused by extra-PV AF sources. Four patients of group A and three patients of group B had continued paroxysmal or persistent AF but did not undergo redo-procedure. With regard to the procedural data, the procedure time, the total energy and the fluoroscopy time were significantly lower in group B (AI and ILD <5 mm) (128.86 ± 18.19 versus 115.35 ± 15.38; p < 0.05; 1619.16 ± 988.56 versus 1186.26 ± 756.34; p < 0.05; 11.49 ± 3.20 versus 9.66 ± 3.86; p = 0.04). Both procedures were performed with a low number of complications, no pericardial effusion was seen in either group. CONCLUSIONS: PVI using ablation index in combination with a stringent lesion contiguity improves clinical outcome after first-time PVI with lower PVI recovery, shorter procedure times, lower total energy and shorter fluoroscopy times and therefore, is more efficient.
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Theis et al. (2021) conducted an observational in Paroxysmal atrial fibrillation (n=100). Pulmonary vein isolation using ablation index and interlesion distance <5 mm vs. Pulmonary vein isolation using contact force and drag-and-ablate technique was evaluated on Freedom from any atrial tachyarrhythmia occurring after the blanking period during a follow-up of at least 12 months (p=0.047). Pulmonary vein isolation using ablation index and an interlesion distance of <5 mm significantly increased arrhythmia-free survival to 86% compared to 72% with contact force-guided ablation.
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