Key result
Ablation index-guided pulmonary vein isolation significantly reduced the 12-month recurrence of atrial fibrillation to 25.8% compared to 40.6% with conventional contact force-based ablation.
Why the study?
Data on the results of catheter ablation for AF in Poland are scarce, and the efficacy of ablation index (AI)-guided PVI compared with conventional contact force-based PVI needed evaluation.
Does ablation index-guided pulmonary vein isolation reduce atrial fibrillation recurrence compared to conventional contact force-based ablation in patients with symptomatic, drug-refractory atrial fibrillation?
Cohort (n=275)
No
Does ablation index-guided pulmonary vein isolation reduce atrial fibrillation recurrence compared to conventional contact force-based ablation in patients with symptomatic, drug-refractory atrial fibrillation?
Absolute Event Rate: 25.8% vs 40.6%
p-value: p=0.02
Ablation index-guided pulmonary vein isolation significantly reduces the rate of atrial fibrillation recurrence compared to conventional contact force-based ablation in an unselected patient population.
Ablation index guidance was associated with fewer AF recurrences; leaves open confirmation of benefit in randomized trials.
BACKGROUND: Data on the results of ablation for atrial fibrillation (AF) in Poland are scarce. AIMS: The aim of the study was to compare the efficacy of ablation index (AI)-guided pulmonary vein isolation (PVI) with that of conventional contact force-based PVI. METHODS: Consecutive patients undergoing PVI for the first time were included in the study. A nonrandomized retrospective comparison was made between patients ablated with contact force before AI was introduced (non -AI group) and patients ablated with the use of AI (AI group). The AI threshold for the anterior wall / roof of left veins was 500 and 380 elsewhere. The maximal interlesion distance was 6 mm. The follow -up included outpatient visits and 7-day Holter monitoring 6 and 12 months after ablation. RESULTS: A total of 275 patients were included in the analysis: 133 in the AI group and 142 in the non--AI group. The duration of AF ablation was slightly longer in the AI group, but the fluoroscopy time and the radiofrequency ablation time were shorter in the same group. During the 12-month follow -up period, 25.8% and 40.6% of patients from the AI and non -AI groups, respectively, experienced recurrences (P = 0.02). The log -rank test with an extended follow -up period of up to 18 months confirmed the difference between the AI and non -AI groups, both in the whole group and in the paroxysmal AF and nonparoxysmal AF subgroups (P = 0.001, P = 0.04, and P = 0.006, respectively). CONCLUSION: The AI -based protocol provides a significant advantage over traditional contact force-based radiofrequency ablation in nonselected patients undergoing PVI.
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Kiliszek et al. (2020) conducted a cohort in Atrial fibrillation (n=275). Ablation index (AI)-guided pulmonary vein isolation vs. Conventional contact force-based pulmonary vein isolation was evaluated on Atrial fibrillation recurrence at 12 months (p=0.02). Ablation index-guided pulmonary vein isolation significantly reduced the 12-month recurrence of atrial fibrillation to 25.8% compared to 40.6% with conventional contact force-based ablation.
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