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. 2022 Apr;13(2):97-103.
doi: 10.14740/cr1337. Epub 2022 Apr 5.

Ablation Index Outcome in Redo Persistent Atrial Fibrillation Ablation: Results of a Short-Term Study

Sarah Jane Lennon  1 , James Mannion  1 , Edward Keelan  1 , Jim O'Brien  1 , Gael Jauvert  1 , Enes Elvin Gul  1 , Usama Boles  1
Affiliations

Ablation Index Outcome in Redo Persistent Atrial Fibrillation Ablation: Results of a Short-Term Study

Sarah Jane Lennon et al. Cardiol Res. 2022 Apr.

Abstract

Background: Ablation index (AI) is a novel catheter-based parameter that has improved the outcome and safety of radiofrequency (RF) ablation of pulmonary vein isolations (PVIs). This index incorporates contact force (CF) (g), time (s), and power (W) parameters. The role of AI in redo ablations for persistent atrial fibrillation (peAF) has not been fully investigated. Hence, the impact of AI on the success of the redo PVI during the short-term follow-up period is the aim of this study.

Methods: A retrospective analysis of 39 consecutive patients who underwent redo PVI ablations for peAF was carried out between January 2016 and December 2018. Target values for AI were 500 - 550 for anterior and roof and 400 - 380 for posterior and inferior regions. We compared outcomes between AI-guided and catheter CF ablations (i.e., forced time integral (FTI) of more than 400 g/s) during a follow-up of 24 months.

Results: Pulmonary vein reconnections at redo procedure were similar in both groups (P = 0.1). AF free burden period was non-significant (mean 15.53 ± 2.4 months in AI group vs. 15.22 ± 1.9 months in CF group, P = 0.79) at 24 months. The AI group demonstrated greater numbers of patients for whom anti-arrhythmic therapy could be de-escalated over 1 year (n = 11 (65%) in AI vs. n = 6 (27%) in CF, P = 0.02). Fewer patients underwent escalation of their anti-arrhythmic therapy (n = 2 (12%) in AI vs. n = 7 (32%) in CF, P = 0.15). The AI group trended towards a shorter procedure time (111.6 ± 27 min) compared to the CF group (133 ± 40 min) (P = 0.06). Other procedural details were comparable.

Conclusion: Redo PVI interventions using AI lead to a significant de-escalation in medication during follow-up. Procedure time and radiation dose using AI tends to be shorter. Both techniques are safe with minimal complications.

Keywords: Ablation index; Contact force; Persistent AF; Pulmonary vein isolation.

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Conflict of interest statement

Limited financial support from J&J to cover the publication fee of the manuscript.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis of AF recurrence at 12 months between the AI and CF groups, following redo PVI procedure, with adjusted 3-month blanking period. Y-axis demonstrates cumulative data for each group. Once AF was detected, the patient’s data were censored from follow-up. Blue line represents the AI interventional group. Red line represents the CF group. AF: atrial fibrillation; AI: ablation index; CF: contact force; PVI: pulmonary vein isolation.
Figure 2
Figure 2
Kaplan-Meier analysis of AF recurrence at 24 months between the AI and CF groups, following redo PVI procedure, with adjusted 3-month blanking period. Blue line represents the AI interventional group. Red line represents the CF group. AF: atrial fibrillation; AI: ablation index; CF: contact force; PVI: pulmonary vein isolation.
See this image and copyright information in PMC

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