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Multicenter Study
. 2022 Jan;63(1):133-142.
doi: 10.1007/s10840-021-00944-w. Epub 2021 Feb 11.

Impact of ablation index settings on pulmonary vein reconnection

A Lepillier  1 , T Strisciuglio  2   3 , E De Ruvo  4 , M Scaglione  5 , M Anselmino  6 , F A Sebag  7 , D Pecora  8 , M M Gallagher  9 , M Rillo  10 , G Viola  11 , E Pisanò  12 , S Abbey  13 , F Lamberti  14 , A Pani  15 , G Zucchelli  16 , G Sgarito  17 , A De Simone  18 , E Bertaglia  19 , F Solimene  2 , Giuseppe Stabile  20   21   22
Affiliations
Free article
Multicenter Study

Impact of ablation index settings on pulmonary vein reconnection

A Lepillier et al. J Interv Card Electrophysiol. 2022 Jan.
Free article

Abstract

Purpose: Ablation index (AI) is a radiofrequency lesion quality marker. The AI value that allows effective and safe pulmonary vein isolation (PVI) is still debated. We evaluated the incidence of acute and late PV reconnection (PVR) with different AI settings and its predictors.

Methods: The Ablation Index Registry is a multicenter study that included patients with paroxysmal/persistent atrial fibrillation (AF) who underwent first-time ablation. Each operator performed the ablation using his preferred ablation catheter (ThermoCool® SmartTouch or Surround Flow) and AI setting (380 posterior-500 anterior and 330 posterior-450 anterior). We divided the study population into two groups according to the AI setting used: group 1 (330-450) and group 2 (380-500). Incidence of acute PVR was validated within 30 min after PVI, whereas the incidence of late PVR was evaluated at repeat procedure.

Results: Overall, 490 patients were divided into groups 1 (258) and 2 (232). There was no significant difference in the procedural time, fluoroscopy time, and rate of the first-pass PVI between the two study groups. Acute PVR was observed in 5.6% PVs. The rate of acute PVR was slightly higher in group 2 (64/943, 6.8%, PVs) than in group 1 (48/1045, 4.6% PVs, p = 0.04). Thirty patients (6%) underwent a repeat procedure and late PVR was observed in 57/116 (49%) PVs (number of reconnected PV per patient of 1.9 ± 1.6). A similar rate of late PVR was found in the two study groups. No predictors of acute and late PVR were found.

Conclusion: Ablation with a lower range of AI is highly effective and is not associated with a higher rate of acute and late PVR. No predictors of PV reconnection were found.

Keywords: Ablation index; Atrial fibrillation; Catheter ablation; Pulmonary vein reconnection.

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References

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