Ablation-index guided versus conventional contact-force guided ablation in pulmonary vein isolation – Systematic review and meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation (n=1727). Intervention: Ablation-index guided ablation vs. Conventional contact-force guided ablation. Primary outcome: 12 months' incidence of atrial fibrillation, atrial flutter, or atrial tachycardia (OR 0.35, 95% CI 0.17, 0.73, p=0.005).

Key Result

Ablation-index guided pulmonary vein isolation significantly reduced the 12-month incidence of atrial arrhythmias compared to conventional contact-force guided ablation (OR 0.35).

Study Design

Type

Meta-Analysis (n=1,727)

PICO

Population

Atrial fibrillation (n=1,727)

Intervention / Comparator

Ablation-index guided ablation vs Conventional contact-force guided ablation

Primary Outcome

12 months' incidence of atrial fibrillation, atrial flutter, or atrial tachycardia — OR 0.35 (0.17, 0.73), p=0.005

Main Result

Effect estimate: OR 0.35 (95% CI 0.17, 0.73)

p-value: p=0.005

Limitations

Included studies were not randomized controlled trials, leading to potential selection bias
Operators for the procedure differed between studies
Small number of included studies and samples
Varying AI targets leading to heterogeneity
Only 12 months of follow-up, so long-term efficacy is unknown
Lack of continuous ECG monitoring may have missed asymptomatic arrhythmias

Abstract

BACKGROUND: Contact-force sensing catheter is widely used for catheter ablation, however, it did not take account of radiofrequency power. Ablation index (AI) is a novel marker incorporating contact force-time-power, was shown to be reliable in predicting lesion size and depth for radiofrequency delivery. We aimed to assess the latest evidence on ablation index guided procedure versus conventional ablation procedure. METHODS: We performed a comprehensive search on topic that assesses ablation index guided procedure versus conventional procedures from inception up until February 2019 through PubMed, EuropePMC, EBSCOhost, Cochrane Central Database, and ClinicalTrials.gov. RESULTS: 95%. Total procedural time and complication rate were similar. CONCLUSION: Ablation index guided procedure resulted in a significantly lower incidence of AF/AT/AFL, shorter fluoroscopy time, and total ablation time. First-pass isolation was higher in AI group and acute PVR was lower in AI group. Ablation-index guided procedure has a similar safety profile to conventional ablation.

Bookmark

View Full Paper

Bookmark

View Full Paper

Cite This Study

Pranata et al. (Fri,) conducted a meta-analysis in Atrial fibrillation (n=1,727). Ablation-index guided ablation vs. Conventional contact-force guided ablation was evaluated on 12 months' incidence of atrial fibrillation, atrial flutter, or atrial tachycardia (OR 0.35, 95% CI 0.17, 0.73, p=0.005). Ablation-index guided pulmonary vein isolation significantly reduced the 12-month incidence of atrial arrhythmias compared to conventional contact-force guided ablation (OR 0.35).

synapsesocial.com/papers/6a0ff35bd13714ec96fee213 https://doi.org/https://doi.org/10.1016/j.ipej.2019.05.001

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: