Ablation Index-guided high-power ablation for superior vena cava
isolation in patients with atrial fibrillation
Abstract
Introduction: The ablation index (AI)-guided high-power
ablation for pulmonary vein isolation (PVI) appears to be a novel
strategy in treating atrial fibrillation (AF). This study aimed to
evaluate the feasibility and safety of superior vena cava isolation
(SVCI) by using an AI-guided high-power ablation strategy among patients
with AF after PVI. Methods and Results: Data from 53 patients
with AF were collected. Mapping and ablation of SVC were performed after
PVI. The ablation power was set to 45 W and the ablation procedure was
guided by AI. The SVC was divided into six segments in a cranial view.
Applications and locations of radiofrequency (RF) were recorded. The RF
applications and AI values in different SVC walls were compared and
analyzed. SVCI was performed in 46 patients and electrical SVCIs were
successfully achieved in all patients with a mean of 7.6 ± 2.9 RF
applications. The mean time of the SVCI procedure was 9.5±4.5 min. The
RF applications were located on different walls (anteroseptal anterior
wall, 20/46 sites [43.5%]; posteroseptal wall, 38/46 sites
[82.6%]; posterior wall, 40/46 sites [87.0%]; anterior walls,
37/46 sites [80.4%]; anterolateral wall, 27/46 sites [58.7%];
posterolateral wall, 23/46 sites [50%]). The mean AI value in
septal, posterior, and anterior walls was higher than that of the
lateral wall (392±28 vs 371±37, P < 0.001). There was no
complication in any cases. Conclusion: AI-guided high-power
ablation is a feasible and safe strategy for performing SVCI. The RF
applications and AI value in different SVC walls varied.