Dataset Information

The Impact of Regional Maximum Tolerated Interlesion Distance on the Long-Term Ablation Outcomes in Ablation Index Guided Pulmonary Vein Isolation for Atrial Fibrillation.

ABSTRACT:

Background

An adequate interlesion distance (ILD) applied during point-by-point pulmonary vein (PV) isolation for atrial fibrillation (AF) has never been established. We hypothesized that maximum tolerated ILD may differ between PV regions and may influence long-term ablation outcomes.

Methods

A total of 260 AF patients underwent PV isolation with 3D electroanatomical platform. Postablation, ILD values were classified into 5 groups (6-5.5 mm, 5.5-5.0 mm, 5.0-4.5 mm, 4.5-4.0 mm and <4.0 mm); the number of tags in each group was calculated and correlated with postablation AF recurrence (AFR). All measurements were performed globally for the entire encirclement around each individual PV and regionally for designated PV anatomic segments.

Results

Single-procedure freedom from AF was 81% for paroxysmal and 66% for persistent AF at 12 months. Global analysis showed that AFR was not related to median ILD nor the number of lesions within each ILD tag group for any PV. Segmental analysis showed that AFR was not related to median ILD. However, the presence of tags from the 5.5-6.0 mm ILD group located on the posterior aspect of right upper PV (RUPV) correlated with AFR. This was confirmed in a multivariable logistic regression model.

Conclusions

Maximum tolerated ILD of 6.0 mm translated into well-accepted ablation results. However, the study suggests that it may be inadequate at the posterior aspect of RUPV.

SUBMITTER: Kiedrowicz RM

PROVIDER: S-EPMC10420066 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

The Impact of Regional Maximum Tolerated Interlesion Distance on the Long-Term Ablation Outcomes in Ablation Index Guided Pulmonary Vein Isolation for Atrial Fibrillation.

Kiedrowicz Radoslaw M RM Wielusinski Maciej M Krasnik Wojciech W Jankowska Olga O Zakrzewski Szymon S Duda Lukasz L Peregud-Pogorzelska Małgorzata M Kladna Aleksandra A Kazmierczak Jaroslaw J

Journal of clinical medicine 20230801 15

<h4>Background</h4>An adequate interlesion distance (ILD) applied during point-by-point pulmonary vein (PV) isolation for atrial fibrillation (AF) has never been established. We hypothesized that maximum tolerated ILD may differ between PV regions and may influence long-term ablation outcomes.<h4>Methods</h4>A total of 260 AF patients underwent PV isolation with 3D electroanatomical platform. Postablation, ILD values were classified into 5 groups (6-5.5 mm, 5.5-5.0 mm, 5.0-4.5 mm, 4.5-4.0 mm and ...[more]

PMID: 37568458

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Project description:BackgroundPulmonary vein isolation (PVI) is a foundational treatment for persistent atrial fibrillation (PeAF), but the effectiveness of adding posterior wall isolation (PWI) and selective complex fractionated atrial electrogram (CFAE) ablation in the roof and anterior wall remains debated. The potential of these additional ablation techniques to improve long-term outcomes for PeAF patients is still uncertain.MethodsThis retrospective study included 151 PeAF patients who underwent first-time catheter ablation at our center. The choice of ablation strategy was based on the operator's clinical judgment, taking into account the patient's specific condition and anatomical features. Patients were divided into two groups: the PVI group, which received PVI alone, and the modified PWI (MPWI) group, which received PVI along with additional PWI and selective CFAEs ablation in the roof and anterior wall. The primary endpoint was the absence of atrial arrhythmia lasting more than 30 s, without antiarrhythmic drugs, at 12 months.ResultsAt the 12-month follow-up, 77.3% of the patients in the MPWI group and 52.1% of the patients in the PVI group remained in sinus rhythm without an atrial arrhythmia recurrence (p = 0.001). The BIC-based Cox regression analysis identified the ablation strategy and atrial fibrillation (AF) duration as independent predictors of recurrence across the cohort. It was found that MPWI significantly reduced the risk of recurrence, while a longer AF duration increased it. In the MPWI group, AF duration, left ventricular internal diameter in systole (LVIDs), and moderate or greater tricuspid regurgitation were independent predictors of recurrence. In the PVI group, only the left atrial low voltage area (LVA) index was a significant predictor.ConclusionThe addition of PWI and selective CFAE ablation to PVI significantly improves 12-month arrhythmia-free survival compared to PVI alone, demonstrating the superiority of this combined approach in improving long-term outcomes for patients with persistent AF.

Dataset Information

The Impact of Regional Maximum Tolerated Interlesion Distance on the Long-Term Ablation Outcomes in Ablation Index Guided Pulmonary Vein Isolation for Atrial Fibrillation.

Background

Methods

Results

Conclusions

Publications

The Impact of Regional Maximum Tolerated Interlesion Distance on the Long-Term Ablation Outcomes in Ablation Index Guided Pulmonary Vein Isolation for Atrial Fibrillation.

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