Key result
Ablation index-guided ablation reduced unadjusted early atrial fibrillation recurrence compared to ablation without contact force guidance (32.8% vs 55.6%, HR 0.494).
Why the study?
Radiofrequency ablation for AF has advanced with contact force-sensing catheters and ablation index, but their influence on outcomes in persistent AF needed evaluation.
Do technological advances including contact force-guided and ablation index-guided ablation improve clinical outcomes and reduce procedural times in patients with persistent atrial fibrillation?
Cohort (n=173)
No
Do technological advances including contact force-guided and ablation index-guided ablation improve clinical outcomes and reduce procedural times in patients with persistent atrial fibrillation?
Hazard Ratio: 0.494 (95% CI 0.284–0.86)
Absolute Event Rate: 32.8% vs 55.6%
p-value: p=0.013
Technological advances in catheter ablation, particularly ablation index guidance, are associated with significantly shorter procedural times and a trend toward reduced atrial fibrillation recurrence in patients with persistent AF.
May reduce PeAF recurrence and complications with CF/AI advances; leaves open prospective multicenter validation before practice change.
We aimed to evaluate the influence of technological advances on ablation outcomes in patients with persistent atrial fibrillation (AF) (PeAF). Radiofrequency ablation for patients with AF has advanced, including contact force (CF)-sensing catheters and the ablation index (AI). Between 2009 and 2018, we analyzed 173 patients with PeAF who underwent catheter ablation. We categorized them into three groups: AF ablation without CF and AI information (no-CF group, n = 63), with CF without AI (CF-only group, n = 49), and with optimal AI-guided ablation (AI group, n = 61). Early (within 3 months, ER) and late (from 3 months to 1 year, LR) AF recurrence after ablation was assessed. Procedure-related complications were also evaluated. The baseline characteristics were similar among the 3 groups, excluding the baseline antiarrhythmic drug history. Additional substrate modification after pulmonary vein isolation was significantly low in frequency in the AI group (71.4%, no-CF; 69.4%, CF-only; 41.0%, AI, p = 0.001). The AI group had a shorter mean procedure-related time than the other groups. Both ER and LR of PeAF showed a trend of reduction with technological advances. With a short experience (less than 1 year), the CF-only group showed more ER and LR than that shown by the AI group. However, with a long experience (more than 1 year), ER and LR occurred similarly in the two groups. Procedure-related complications improved with technological advances. As ablation technology advanced, favorable clinical outcomes with short procedural times were observed. However, prospective, large multicenter studies are needed to verify these results.
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Jeon et al. (2022) conducted a cohort in Persistent atrial fibrillation (n=173). Ablation index-guided ablation vs. Ablation without contact force and ablation index information was evaluated on Early recurrence of atrial fibrillation (within 3 months) (HR 0.494, 95% CI 0.284-0.860, p=0.013). Ablation index-guided ablation reduced unadjusted early atrial fibrillation recurrence compared to ablation without contact force guidance (32.8% vs 55.6%, HR 0.494).
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