Key result
Ablation index-guided PVI is linked to ~59% lower early arrhythmia recurrence versus contact force-guided PVI.
Why the study?
Early recurrence of atrial tachyarrhythmias (ERAT) after pulmonary vein isolation (PVI) causes symptoms and predicts worse outcomes, but the effect of ablation index (AI) guided PVI on ERAT compared to conventional contact force (CF) guided PVI was unclear.
Does AI-guided PVI reduce early recurrence of atrial tachyarrhythmias in patients with atrial fibrillation compared to CF-guided PVI?
Cohort (n=697)
Does AI-guided PVI reduce early recurrence of atrial tachyarrhythmias in patients with atrial fibrillation compared to CF-guided PVI?
Odds Ratio: 0.415 (95% CI 0.269–0.639)
Absolute Event Rate: 21.5% vs 36.1%
p-value: p=<0.001
Ablation index-guided PVI significantly reduces early recurrences of atrial tachyarrhythmias and late pulmonary vein reconnection compared to conventional contact force-guided PVI.
AI-guided PVI was associated with fewer early recurrences; hypothesis-generating and requires randomized confirmation before practice change.
Introduction: Early recurrence of atrial tachyarrhythmias (ERAT) cause various symptoms and predict worse outcomes after pulmonary vein isolation (PVI). This study aimed to clarify whether ablation index (AI) guided PVI, which is a novel technology of radiofrequency ablation, could reduce ERAT as compared to conventional contact force (CF) guided PVI. Methods: Consecutive AF patients who underwent initial PVI from September 2014 to August 2019 were enrolled. We divided the patients into two groups: patients who underwent AI-guided PVI (AI group) and those who underwent CF-guided PVI (CF group). Using propensity score matching (PSM), we adjusted for the patient backgrounds. We compared the incidence of ERAT and late reconnection rate of isolated PVs during second session between the two groups. ERAT was defined as any atrial tachyarrhythmias ≥30 seconds during a 90-day blanking period. Results: A total of 697 patients (paroxysmal 51%) were enrolled. After the PSM, both groups included 229 patients. The incidence of ERAT was significantly lower in AI group than CF group (21.5% vs. 36.1%, P<0.001). The rate of PV reconnection was lower in AI group than CF group (45.8% vs. 71.4%, P=0.028). Multivariate analysis demonstrated that AI-guided PVI was independently correlated with the incidence of ERAT (OR=0.415, 95%CI=0.269-0.639, P<0.001). Conclusion: AI-guided PVI can reduce ERAT as compared to conventional CF-guided PVI.
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Yasumoto et al. (2020) conducted a cohort in Atrial fibrillation (n=697). Ablation index (AI) guided pulmonary vein isolation vs. Conventional contact force (CF) guided pulmonary vein isolation was evaluated on Early recurrence of atrial tachyarrhythmias (ERAT) ≥30 seconds during a 90-day blanking period (OR 0.415, 95% CI 0.269-0.639, p=<0.001). Ablation index-guided pulmonary vein isolation significantly reduced early recurrence of atrial tachyarrhythmias compared to contact force-guided PVI (21.5% vs. 36.1%; OR 0.415, 95% CI 0.269-0.639).
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