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. 2020 Oct;59(1):21-27.
doi: 10.1007/s10840-019-00622-y. Epub 2019 Oct 17.

The industrialization of ablation: a highly standardized and reproducible workflow for radiofrequency ablation of atrial fibrillation

Tom De Potter  1 , Tina D Hunter  2 , Lee Ming Boo  3 , Sofia Chatzikyriakou  4   5 , Teresa Strisciuglio  4   6 , Etel Silva  4 , Peter Geelen  4
Affiliations

The industrialization of ablation: a highly standardized and reproducible workflow for radiofrequency ablation of atrial fibrillation

Tom De Potter et al. J Interv Card Electrophysiol. 2020 Oct.

Abstract

Background or purpose: The purpose of this analysis was to report on efficacy of a standardized workflow for atrial fibrillation (AF) ablation using technology advances such as 3D imaging and contact force sensing in a real-world setting.

Methods: Consecutive AF ablations from 2014 to 2015 at a high-volume site in Belgium were included. The workflow consisted of a pre-specified procedure sequence including 3D modeling followed by radiofrequency encircling of the pulmonary veins (25 W posterior wall, 35 W anterior wall) with a THERMOCOOL SMARTTOUCH® Catheter guided by CARTO VISITAG™ Module (2.5 mm/5 s stability, 50% > 7 g) and ablation index (targets: 550 anterior wall, 400 posterior wall). Efficiency endpoints were procedure time, fluoroscopy time, and radiation dose. The primary effectiveness endpoint was freedom from atrial arrhythmia recurrence.

Results: A total of 605 paroxysmal AF (PAF) and 182 persistent AF (PsAF) patients were followed for 436 ± 199 days. Mean procedure times were short (PAF: 96.1 ± 26.2 min; PsAF: 109.2 ± 35.6 min) with most procedures (90.6% PAF; 81.3% PsAF) completed in ≤ 120 min. Minimal fluoroscopy was utilized (PAF: 6.1 ± 3.8 min, 5.9 ± 3.4 Gy*cm2; PsAF: 6.9 ± 4.7 min, 7.4 ± 4.9 Gy*cm2). Freedom from atrial arrhythmia recurrence was higher for PAF than PsAF patients (OR: 2.0, 95% CI: 1.4-2.9, p = 0.0003), but adjusted mean rates were high in both groups (81.0% vs. 67.9%). Rates were adjusted for prior ablation and age (at 65 years).

Conclusion: AF ablation using a standardized workflow resulted in low procedure times and variability, with minimal fluoroscopy exposure. Long-term freedom from atrial arrhythmia recurrence was high in both PAF and PsAF populations.

Keywords: Arrhythmias; Atrial fibrillation; Catheter ablation.

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Conflict of interest statement

T De Potter, S Chatzikyriakou, E Silva Garcia, and P Geelen have no disclosures. T Strisciuglio has been supported by a research grant provided by the CardioPath PhD program. TD Hunter is an employee of CTI Clinical Trial and Consulting Services, which is a consultant to Biosense Webster, Inc. L Boo is an employee of Biosense Webster, Inc.

Figures

Fig. 1
Fig. 1
Ablation workflow schematic. *Segmentation could also be done with CARTO® “image integration” tool. In that case, the output of the 3D reconstruction can be directly retrieved from CARTO®
Fig. 2
Fig. 2
Adjusted mean rates of freedom from atrial arrhythmia recurrence. Error bars represent the standard error of the adjusted mean. Rates were calculated at 65 years of age. PAF: paroxysmal atrial fibrillation, PsAF: persistent atrial fibrillation
See this image and copyright information in PMC

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