Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values
Top Cited Papers
Open Access
- 31 May 2016
- journal article
- research article
- Published by Oxford University Press (OUP) in EP Europace
- Vol. 19 (5), 775-783
- https://doi.org/10.1093/europace/euw105
Abstract
Force–Time Integral (FTI) is commonly used as a marker of ablation lesion quality during pulmonary vein isolation (PVI), but does not incorporate power. Ablation Index (AI) is a novel lesion quality marker that utilizes contact force, time, and power in a weighted formula. Furthermore, only a single FTI target value has been suggested despite regional variation in left atrial wall thickness. We aimed to study AI's and FTI's relationships with PV reconnection at repeat electrophysiology study, and regional threshold values that predicted no reconnection. Forty paroxysmal atrial fibrillation patients underwent contact force-guided PVI, and the minimum and mean AI and FTI values for each segment were identified according to a 12-segment model. All patients underwent repeat electrophysiology study at 2 months, regardless of symptoms, to identify sites of PV reconnection. Late PV reconnection was seen in 53 (11%) segments in 25 (62%) patients. Reconnected segments had significantly lower minimum AI [308 (252–336) vs. 373 (323–423), P < 0.0001] and FTI [137 (92–182) vs. 228 (157–334), P < 0.0001] compared with non-reconnected segments. Minimum AI and FTI were both independently predictive, but AI had a smaller P value. Higher minimum AI and FTI values were required to avoid reconnection in anterior/roof segments than for posterior/inferior segments (P < 0.0001). No reconnection was seen where the minimum AI value was ≥370 for posterior/inferior segments and ≥480 for anterior/roof segments. The minimum AI value in a PVI segment is independently predictive of reconnection of that segment at repeat electrophysiology study. Higher AI and FTI values are required for anterior/roof segments than for posterior/inferior segments to prevent reconnection.Keywords
Funding Information
- Biosense Webster, Inc. (IIS-239)
This publication has 20 references indexed in Scilit:
- Target Indices for Clinical Ablation in Atrial FibrillationCirculation: Arrhythmia and Electrophysiology, 2014
- Catheter-Tissue Contact Force Determines Atrial Electrogram Characteristics Before and Lesion Efficacy After Antral Pulmonary Vein Isolation in HumansJournal of Cardiovascular Electrophysiology, 2013
- Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial TreatmentCirculation: Arrhythmia and Electrophysiology, 2013
- Predictive value of impedance changes for real-time contact force measurements during catheter ablation of atrial arrhythmias in humansHeart Rhythm, 2013
- 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial DesignA report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm SocietyEP Europace, 2012
- Left Atrial Anatomy RevisitedCirculation: Arrhythmia and Electrophysiology, 2012
- Prospective, multicentre validation of a simple, patient-operated electrocardiographic system for the detection of arrhythmias and electrocardiographic changesEP Europace, 2009
- Impedance and Temperature Monitoring Improve the Safety of Closed-Loop Irrigated-Tip Radiofrequency AblationJournal of Cardiovascular Electrophysiology, 2007
- Assessment of myocardial lesion size during in vitro radio frequency catheter ablationIEEE Transactions on Biomedical Engineering, 2003
- Control of radiofrequency lesion size by power regulation.Circulation, 1989