Key result
Inter-tag distance ≥4 mm linked to ~6.6-fold higher risk of ablation gap formation.
Why the study?
Optimal VISITAG SURPOINT thresholds for pulmonary vein isolation depend on inter-tag distance and vice versa, prompting validation of lower target inter-tag distances and VS values.
Does VISITAG SURPOINT-guided catheter ablation with lower target inter-tag distances and VS values provide safe and durable pulmonary vein isolation in patients with atrial fibrillation?
Cohort (n=100)
No
Does VISITAG SURPOINT-guided catheter ablation with lower target inter-tag distances and VS values provide safe and durable pulmonary vein isolation in patients with atrial fibrillation?
Utilizing lower VISITAG SURPOINT values while strictly maintaining an inter-tag distance <4 mm results in durable pulmonary vein isolation and favorable long-term outcomes in AF ablation.
Answers are grounded in this paper and cite their sources.
Strict inter-tag distance <4 mm may reduce gaps in VISITAG SURPOINT ablation; leaves open optimal targets for durable PVI in prospective trials.
Purpose Although usefulness of VISITAG SURPOINT (VS) on pulmonary vein isolation (PVI) in catheter ablation of atrial fibrillation has been reported, optimal VS thresholds can depend on the inter‐tag distance (ITD) and vice versa. We validated the efficacy of PVI with lower target ITDs and VS values than in previous studies. Methods Retrospective review of consecutive patients (N = 100) with paroxysmal (n = 32) or persistent AF (n = 68) undergoing VS‐guided ablation between 09/2018 and 08/2019 was conducted. All procedures were performed by two operators. Target VS values were 425 (anterior), 375 (posterior), and 325 (near the esophagus). Target ITD was 4 mm. Results Acute PVI was achieved in all cases, however, 13 residual gaps in 12 patients were observed after initial encirclement (first pass isolation: 88%). Ten gaps due to spontaneous PV reconnections (PVR) were found in nine patients (9%). These 23 gaps had similar median VS (gap‐related vs non‐gap: 429 vs 410, P = .4545) and power (36 vs 36W, P = .4843), higher contact force (13.8 vs 11.0g, P = .0061), and larger ITD (5.3 vs 3.7mm, P < .001) when compared to the remaining tags. Only ITDs were independently associated with gap formation in multivariate analysis. One‐year Kaplan‐Meier freedom from any atrial arrhythmia was 87.2%. Eight patients received repeat ablation (8.1%) and of these, 6 (75%) were free from PVR. Conclusion Favorable rates of first pass isolation, acute PVR, and long‐term procedure success were achieved using lower VS values than in previous reports. With a target VS value of 375‐425, ITDs of 4 mm was sufficient for durable PVI.
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Inoue et al. (2021) conducted a cohort in Paroxysmal or persistent atrial fibrillation (n=100). VISITAG SURPOINT-guided catheter ablation (target inter-tag distance <4 mm) was evaluated on Gap formation associated with inter-tag distance ≥4 mm (per-tag analysis) (OR 6.6051, 95% CI 2.2444-19.4387, p=0.0006). In VISITAG SURPOINT-guided catheter ablation, an inter-tag distance ≥4 mm was independently associated with an increased risk of gap formation, while the overall protocol achieved an 87.2% one-year freedom from atrial arrhythmias.
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