Journal article
Extensive Posterior Wall Isolation on Top of Pulmonary Vein Isolation Guided by Ablation Index in Persistent Atrial Fibrillation Ablation
Life (Basel, Switzerland), Vol.13(3), p.761
03/01/2023
DOI: 10.3390/life13030761
PMCID: PMC10052169
PMID: 36983916
Abstract
Background: Durable pulmonary vein isolation (PVI) is recommended for symptomatic paroxysmal atrial fibrillation (AF) treatment, but it has been demonstrated that it may not be enough to treat persistent AF (Pe-AF). Therefore, posterior wall isolation (PWI) is among the strategies adopted on top of PVI to treat Pe-AF patients. However, PWI using contiguous and optimized radiofrequency lesions remains challenging, and few studies have evaluated the impact of the Ablation Index (AI) on the efficacy of PWI. Moreover, previous papers did not evaluate arrhythmia recurrences using continuous monitoring. Methods: This is a prospective, observational, single-center study on patients affected by Pe-AF undergoing treated PVI plus AI-guided PWI. Procedures were performed using the CARTO mapping system, SmartTouch SF ablation catheter, and PentaRay multipolar mapping catheter. The AI settings were 500-550 for the anterior PV aspect and roofline, while the settings were 450-500 for the posterior PV aspect, bottom line, and/or PW lesions. All patients received an implantable loop recorder (ILR). All patients underwent clinical evaluation in the outpatient clinic at 1, 3, 6, 12, 18, and 24 months. A standard 12-lead ECG was performed at each visit, and device data from the ILR were reviewed to assess for arrhythmia recurrence. Results: Between January 2021 and December 2021, forty-one consecutive patients underwent PVI plus PWI guided by AI at our center and were prospectively enrolled in the study. PVI was achieved in all patients, first-pass roofline block was obtained in 82.9% of the patients, and first-pass block of the bottom line was achieved in 36.5% of the patients. In 39% of the patients, PWI was not performed with a "box-only" lesion set, but with scattered lesions across the PW to achieve PWI. AI on the anterior aspect of the left PVs was 528 +/- 22, while on the posterior aspect of the left PVs, it was 474 +/- 18; on the anterior aspect of the right PVs, it was 532 +/- 27, while on the posterior aspect of the right PVs, it was 477 +/- 16; on the PW, AI was 468 +/- 19. No acute complications occurred at the end of the procedure. After the blanking period, 70.7% of the patients reported no arrhythmia recurrence during the 12-month follow-up period. Conclusions: In patients with Pe-AF undergoing catheter ablation, PWI guided by AI seems to be an effective and feasible strategy in addition to standard PVI.
Details
- Title: Subtitle
- Extensive Posterior Wall Isolation on Top of Pulmonary Vein Isolation Guided by Ablation Index in Persistent Atrial Fibrillation Ablation
- Creators
- Francesco Sabatino - ARNAS Civ Di Cristina Benfratelli, Dept Electrophysiol, I-90127 Palermo, ItalyDomenico Oriente - Azienda Osped Univ Policlin Paolo Giaccone, Dept Cardiol, I-90127 Palermo, ItalyFabrizio Fortunato - Azienda Osped Univ Policlin Paolo Giaccone, Dept Cardiol, I-90127 Palermo, ItalyAntonio Cascino - ARNAS Civ Di Cristina Benfratelli, Dept Electrophysiol, I-90127 Palermo, ItalyGiuliano Ferrara - ARNAS Civ Di Cristina Benfratelli, Dept Electrophysiol, I-90127 Palermo, ItalyGiuseppe Sgarito - ARNAS Civ Di Cristina Benfratelli, Dept Electrophysiol, I-90127 Palermo, ItalySergio Conti - ARNAS Civ Di Cristina Benfratelli, Dept Electrophysiol, I-90127 Palermo, Italy
- Resource Type
- Journal article
- Publication Details
- Life (Basel, Switzerland), Vol.13(3), p.761
- DOI
- 10.3390/life13030761
- PMID
- 36983916
- PMCID
- PMC10052169
- NLM abbreviation
- Life (Basel)
- ISSN
- 2075-1729
- eISSN
- 2075-1729
- Publisher
- Mdpi
- Number of pages
- 11
- Language
- English
- Date published
- 03/01/2023
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984822989202771
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