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Wall Thickness-Based Adjustment of Ablation Index Improves Efficacy of Pulmonary Vein Isolation in Atrial Fibrillation: Real-Time Assessment by Intracardiac Echocardiography
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  • Yuji Motoike,
  • Masahide Harada,
  • Takehiro Ito,
  • Yoshihiro Nomura,
  • Asuka Nishimura,
  • Masayuki Koshikawa,
  • Eiichi Watanabe,
  • Yukio Ozaki,
  • Hideo Izawa
Yuji Motoike
Fujita Health University
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Masahide Harada
Fujita Health University
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Takehiro Ito
Fujita Health University
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Yoshihiro Nomura
Fujita Health University
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Asuka Nishimura
Fujita Health University
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Masayuki Koshikawa
Fujita Health University
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Eiichi Watanabe
Fujita Health University School of Medicine
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Yukio Ozaki
Fujita Health University School of Medicine
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Hideo Izawa
Fujita Health University
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Abstract

Background: Ablation index (AI) linearly correlates with lesion depth and may yield better therapeutic performance in pulmonary vein isolation (PVI) when tailored to a patient’s wall thickness (WT) in the left atrium (LA). Methods and results: (First study) In paroxysmal atrial fibrillation patients (PAF, n=20), the average LA WT (mm) in each anatomical segment for PVI was measured by intra-cardiac echocardiography (ICE) placed in the LA; the optimal AI for creating one-millimeter transmural lesion (AI/mm) was calculated. (Second study) PAF (n=80) patients were randomly assigned either to a force-time integral protocol (FTI, 400 gram·second, n=40) or a tailored-AI protocol (TAI, n=40). In TAI, the LA WT in each segment was individually measured by ICE before starting ablation; a target AI was adjusted according to the individual WT in each segment (AI/mm×WT). The acute procedure outcomes and the 1-year AF recurrence rate were compared between FTI and TAI. TAI had higher success rate of first-pass isolation and had lower incidence of residual PV-potentials/conduction gaps after a circular ablation than FTI (88% vs. 65%, 15 vs. 45%, respectively). The procedure time to complete PVI decreased in TAI compared to FTI (52 vs. 83 minutes), being attributed to the increased radiofrequency power and the decreased radiofrequency application time in each point in TAI. TAI had lower 1-year AF recurrence rate than FTI. Conclusion: WT-based AI-adjustment increased acute procedure success, decreased time for PVI, and reduced 1-year AF recurrence rate. Understanding the precise ablation target would improve the efficacy of PVI.

Peer review status:Published

01 Nov 2020Submitted to Journal of Cardiovascular Electrophysiology
02 Nov 2020Submission Checks Completed
02 Nov 2020Assigned to Editor
02 Nov 2020Reviewer(s) Assigned
16 Nov 2020Review(s) Completed, Editorial Evaluation Pending
17 Nov 2020Editorial Decision: Revise Minor
10 Jan 20211st Revision Received
14 Jan 2021Assigned to Editor
14 Jan 2021Submission Checks Completed
14 Jan 2021Reviewer(s) Assigned
17 Jan 2021Review(s) Completed, Editorial Evaluation Pending
17 Jan 2021Editorial Decision: Revise Minor
31 Jan 20212nd Revision Received
01 Feb 2021Assigned to Editor
01 Feb 2021Submission Checks Completed
01 Feb 2021Review(s) Completed, Editorial Evaluation Pending
01 Feb 2021Editorial Decision: Accept
11 Mar 2021Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.15000