Characterizing Clinical Outcomes and Factors Associated with Conduction Gaps in VISITAG SURPOINT-Guided Catheter Ablation for Atrial Fibrillation

Background: Few studies have explored the link between VISITAG SURPOINT (VS) parameters and the inter-tag distance (ITD) on pulmonary vein isolation (PVI) in catheter ablation of atrial fibrillation (AF). Objective: To examine the clinical outcomes and factors contributing to residual conduction and reconnection gaps during PVI. Methods and Results: A retrospective review of consecutive patients (N=100) with paroxysmal (n=32) or persistent AF (n=68) undergoing VS-guided ablation between 09/2018-08/2019 was performed. All procedures were performed by 2 operators. Target VS values were 425 (anterior), 375 (posterior), and 325 (in proximity of the esophagus). Target ITD was 4 mm. Acute PVI was achieved in 100% of cases, however 13 residual gaps in 12 patients were observed after the first encirclement (first pass isolation: 88%). Ten gaps due to spontaneous PV reconnections (PVR) were found in 9 patients (9%). Tags associated with these 23 gaps had similar median VS (gap-related vs. non-gap: 429 vs. 410, p=0.4545) and power (36 vs. 36W, p=0.4843), higher contact force (13.8 vs. 11.0g, p=0.0061), and larger ITD (5.3 vs. 3.7mm, p<0.001) when compared to the remaining tags. At median follow-up of 462 days (N=99 patients), freedom from any atrial arrhythmia was 84.8%. Eight patients received repeat ablation (8.1%) and of these, 6 (75%) were free from PVR. No major adverse events were noted. Conclusion: Favorable rates of first pass isolation, acute PVR, and long-term procedure success were achieved using lower VS values than in previous reports. Under these settings, larger ITDs are associated with residual conduction and reconnections.