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Ablation Index Guided Left Atrial Posterior Wall Isolation.
Yu Makihara1, Shinsuke Miyazaki2, Tomoko Harama1
1Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center.
International Heart Journal
|July 31, 2022
Summary
A higher target Ablation Index (AI) of 450 improved first-pass success for left atrial posterior wall isolation in atrial fibrillation patients. This AI-guided approach enhances procedural efficiency and lesion completeness.
Area of Science:
- Electrophysiology
- Cardiology
- Medical Devices
Background:
- Linear ablation in the left atrium (LA) is crucial for treating persistent atrial fibrillation (AF).
- Ablation Index (AI)-guided ablation offers a quantitative approach to ensure lesion transmurality and continuity.
- Optimizing AI target values is essential for improving the efficacy of LA posterior wall isolation (PWI).
Purpose of the Study:
- To evaluate the feasibility and effectiveness of AI-guided LA posterior wall isolations (PWIs) using different target AI values.
- To compare the success rates of first-pass PWIs and linear block achievement between distinct AI target groups.
- To identify procedural parameters influencing the success of AI-guided linear ablation in the LA.
Main Methods:
- Retrospective analysis of 71 persistent AF patients undergoing AI-guided PWIs after pulmonary vein isolation.
- LA linear lesions created with strict contiguity (< 4 mm inter-lesion distance) and target AI values of 430 (Group-1) or 450 (Group-2).
- Assessment of first-pass success rates for PWI, roof line, and bottom line blocks, along with radiofrequency (RF) application parameters.
Main Results:
- Group-2 (target AI 450) demonstrated significantly higher first-pass PWI (74.3% vs. 44.4%) and roof line block (80.0% vs. 58.3%) success rates compared to Group-1 (target AI 430).
- First-pass bottom line block success was similar between groups (approx. 80%).
- Higher RF power and shorter inter-lesion distance were associated with successful first-pass roof and bottom line blocks, respectively. Conduction gaps were primarily in the middle of lines, with roof line gaps occasionally requiring ablation within the posterior wall.
Conclusions:
- A target AI value of 450, combined with strict lesion contiguity, significantly improves first-pass success rates for AI-guided LA posterior wall isolation.
- AI-guided linear ablation is feasible, with higher target AI values potentially enhancing procedural efficiency.
- Optimizing RF power and ensuring lesion contiguity are key factors for achieving complete linear block during AI-guided LA ablation.
