Effectiveness of first-pass pulmonary vein isolation with index-guided ablation compared to very-high-power, short-duration ablation: A retrospective single-center study
Abstract
Background: Pulmonary vein isolation is the cornerstone of atrial fibrillation treatment. First-pass pulmonary vein isolation is defined as isolation achieved with only a single lesion in every part of the isolation lines.
Aims: The primary aim was to assess the frequency of first-pass pulmonary vein isolation after ablation index-guided (AI) and very-high-power, short-duration (vHPSD) ablation. The secondary goals were to detect areas of additional lesions and the correlation between them and used methods and to access efficiency of the procedure.
Methods: In this retrospective, single-center study, we included 105 consecutive patients undergoing pulmonary vein isolation for paroxysmal or persistent atrial fibrillation. Based on the operators’ decisions, 51 patients underwent AI-guided, and 54 patients underwent vHPSD ablation. The ipsilateral pulmonary veins were divided into four areas, and the anatomical region and several additional applications were evaluated.
Results: Bilateral first-pass pulmonary vein isolation was achieved in 34.3% of patients, with no significant difference between AI-guided and vHPSD ablation (37.0% vs. 31.4%; P = 0.68). In both groups, the most common region of additional applications was the posterior part of the right-sided carina (AI: 25.5% [13/51] vs. vHPSD: 25.9% [14/54]; P = 0.89). There was a significant difference (P = 0.049) between techniques in the highest frequency of additional applications in the left-sided pulmonary veins: in the anterior part of the carina (AI: 15.7% vs. vHPSD: 7.4%) and the posterior part of the carina (AI: 5.9% vs. vHSPD: 22.2%).
Conclusions: Lesions made with AI-guided and vHPSD protocols differed in areas of additional applications, which was most significant in the left-sided pulmonary veins.
Keywords: atrial fibrillationcatheter ablationfirst-pass isolationpulmonary vein isolationvHPSD
References
- Hindricks G, Potpara T, Dagres N, et al. ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42(5): 373–498.
- Benjamin EJ, Muntner P, Alonso A, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019; 139(10): e56–e5e528.
- Turagam MK, Musikantow D, Whang W. Assessment of Catheter Ablation or Antiarrhythmic Drugs for First-line Therapy of Atrial Fibrillation: A Meta-analysis of Randomized Clinical Trials. JAMA Cardiol. 2021; 6(6): 697–705.
- Fink T, Sciacca V, Nischik F, et al. Atrial fibrillation ablation workflow optimization facilitated by high-power short-duration ablation and high-resolution mapping. Europace. 2024; 26(3).
- Kreidieh O, Hunter TD, Goyal S, et al. Investigators of the REAL AF registry. Predictors of first pass isolation of the pulmonary veins in real world ablations: An analysis of 2671 patients from the REAL-AF registry. J Cardiovasc Electrophysiol. 2024; 35(3): 440–450.
- Phlips T, Taghji P, El Haddad M, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the 'CLOSE'-protocol. Europace. 2018; 20(FI_3): f419–f427.
- Mitrzak K, Peller M, Krzowski B, et al. Safety and effectiveness of very-high-power, short-duration ablation in patients with atrial fibrillation: Preliminary results. Cardiol J. 2024; 31(4): 603–611.
- Kotadia ID, Williams SE, O'Neill M. High-power, Short-duration Radiofrequency Ablation for the Treatment of AF. Arrhythm Electrophysiol Rev. 2020; 8(4): 265–272.
- Lozano-Granero C, Franco E, Matía-Francés R, et al. Characterization of high-power and very-high-power short-duration radiofrequency lesions performed with a new-generation catheter and a temperature-control ablation mode. J Cardiovasc Electrophysiol. 2022; 33(12): 2528–2537.
- Tzeis S, Gerstenfeld EP, Kalman J, et al. 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2024; 26(4).
- Akca F, Janse P, Theuns DA, et al. A prospective study on safety of catheter ablation procedures: contact force guided ablation could reduce the risk of cardiac perforation. Int J Cardiol. 2015; 179: 441–448.
- Jankelson L, Dai M, Aizer A, et al. Lesion Sequence and Catheter Spatial Stability Affect Lesion Quality Markers in Atrial Fibrillation Ablation. JACC Clin Electrophysiol. 2021; 7(3): 367–377.
- Ninomiya Y, Inoue K, Tanaka N, et al. Absence of first-pass isolation is associated with poor pulmonary vein isolation durability and atrial fibrillation ablation outcomes. J Arrhythm. 2021; 37(6): 1468–1476.
- Stauffer N, Knecht S, Badertscher P, et al. Repeat catheter ablation after very late recurrence of atrial fibrillation after pulmonary vein isolation. Europace. 2024; 26(5).
- Wang K, Jin C, Chen H, et al. General anesthesia enhances lesion quality and ablation efficiency of circumferential pulmonary vein isolation. J Arrhythm. 2024; 40(1): 76–82.
