loading page

Characterizing Clinical Outcomes and Factors Associated with Conduction Gaps in VISITAG SURPOINT-Guided Catheter Ablation for Atrial Fibrillation
  • +7
  • Koichi Inoue,
  • Nobuaki Tanaka,
  • Yusuke Ikada,
  • Akinobu Mizutani,
  • Kazuhiko Yamamoto,
  • Hana Matsushima,
  • Shinichi Harada,
  • Masato Okada,
  • Katsuomi Iwakura,
  • Kenshi Fujii
Koichi Inoue
Sakurabashi Watanabe Hospital
Author Profile
Nobuaki Tanaka
Sakurabashi Watanabe Hospital
Author Profile
Yusuke Ikada
Sakurabashi Watanabe Hospital
Author Profile
Akinobu Mizutani
Sakurabashi Watanabe Hospital
Author Profile
Kazuhiko Yamamoto
Sakurabashi Watanabe Hospital
Author Profile
Hana Matsushima
Sakurabashi Watanabe Hospital
Author Profile
Shinichi Harada
Sakurabashi Watanabe Hospital
Author Profile
Masato Okada
Sakurabashi Watanabe Hospital
Author Profile
Katsuomi Iwakura
Sakurabashi Watanabe Hospital
Author Profile
Kenshi Fujii
Sakurabashi Watanabe Hospital
Author Profile

Abstract

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.

Peer review status:Published

07 May 2021Published in Journal of Arrhythmia. 10.1002/joa3.12544