Favorable Effects of AI on ERATs
In this study, we revealed that AI-guided PVI could reduce ERATs more than CF-guided PVI. Tokuda et al. reported that the incidence of ERAT after PVI for PAF was similar between Cryoballoon ablation and conventional radiofrequency CA (21% vs. 27%, p=0.15).11 We considered that AI-guided PVI was the most effective modality for reducing ERATs in PAF patients (15.2%).
Preclinical studies in an animal model have demonstrated that AI accurately predicts the depth of ablation lesions.9AI-guided PVI can produce a higher impedance drop, and AI plays a role as a parameter of the effectiveness of a lesion formation.12 Several reports have demonstrated that AI-guided PVI could achieve a durable PVI and reduce late PV reconnections,13 which is consistent with our results. We considered that AI could reduce late PV reconnections, which could lead to reduction in ERATs.
In our study, AI-guided PVI decreased late PV reconnections, especially RSPV. Septopulmonary bundle runs through the RSPV ostium, which is relatively thick LA muscular bundle and renders RSPV isolation difficult.14 We suggested that AI-guided ablation could form transmural ablation lesion at this site, that lead to less reconnection of RSPV. Furthermore, the localization of focal AF triggers occurs frequently in RSPV.15 On the other hand, the rate of left PV reconnections was similar between AI group and CF group, which could be explained by the fact that we attenuated the radiofrequency delivery to the LPV posterior wall to prevent esophageal injury in both 2 groups.