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Comparison of the efficacy between impedance-guided and contact force-guided atrial fibrillation ablation using an automated annotation system.

ABSTRACT: Background:This study compared the efficacy of catheter ablation of atrial fibrillation (AF) between impedance (IMP)-guided and contact force (CF)-guided annotation using the automated annotation system (VisiTag™). Methods:Fifty patients undergoing pulmonary vein isolation (PVI) for AF were randomized to the IMP-guided or CF-guided groups. The annotation criteria for VisiTag™ were a 10 second minimum ablation time and 2 mm maximum catheter movement range. A minimum CF of 10 g was added to the criteria in the CF-guided group. In the IMP-guided group, a minimum IMP drop of over 5 ? was added to the criteria. Results:The rates of successful PVI after an initial ablation line were higher in the CF-guided group (80% vs 48%, P = .018). Although average CF was similar between two groups, the average force-time integral (FTI) was significantly higher in the CF-guided group (298.3 ± 65. 2 g·s vs 255.1 ± 38.3 g·s, P = .007). The atrial arrhythmia-free survival at 1 year demonstrated no difference between the two groups (84.0% in the IMP-guided group vs 80.0% in the CF-guided group, P = .737). If the use of any antiarrhythmic drug beyond the blanking period was considered as a failure, the clinical success rate at 1 year was 52.0% for the CF-guided group vs 56.0% for the IMP-guided group (P = .813). Conclusions:Atrial fibrillation ablation using an automated annotation system guided by CF improved the success rate of PVI after the initial circumferential ablation. An IMP-guided annotation combined with catheter stability criteria showed similar clinical outcomes as compared to the CF-guided annotation.

SUBMITTER: Park HS

PROVIDER: S-EPMC6010015 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Comparison of the efficacy between impedance-guided and contact force-guided atrial fibrillation ablation using an automated annotation system.

Park Hyoung-Seob HS Kim In-Cheol IC Cho Yun-Kyeong YK Yoon Hyuck-Jun HJ Kim Hyungseop H Nam Chang-Wook CW Han Seongwook S Hur Seung-Ho SH Kim Yoon-Nyun YN Kim Kwon-Bae KB

Journal of arrhythmia 20180411 3

<h4>Background</h4>This study compared the efficacy of catheter ablation of atrial fibrillation (AF) between impedance (IMP)-guided and contact force (CF)-guided annotation using the automated annotation system (VisiTag™).<h4>Methods</h4>Fifty patients undergoing pulmonary vein isolation (PVI) for AF were randomized to the IMP-guided or CF-guided groups. The annotation criteria for VisiTag™ were a 10 second minimum ablation time and 2 mm maximum catheter movement range. A minimum CF of 10 g was ...[more]

PMID: 29951138

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Project description:IntroductionAblation Index, also known as VISITAG SURPOINT™, is a novel lesion-quality marker that improves outcomes in radiofrequency (RF) catheter ablation of atrial fibrillation (AF). There is no direct evidence on the comparative effectiveness of RF ablation with Ablation Index and cryoballoon (CB). The objective of the present study was to conduct a matching-adjusted indirect comparison (MAIC) using individual patient-level data (IPD) to compare the effectiveness of RF ablation with Ablation Index to that of CB on recurrence of atrial arrhythmias 12 months after catheter ablation in patients with paroxysmal AF (PAF).MethodsIndividual patient-level data for RF ablation with Ablation Index were obtained from two studies: Solimene et al. [J Interv Card Electrophysiol 54(1):9-15, 2019] and Hussein et al. [J Cardiovasc Electrophysiol 28(9):1037-1047, 2017]. Comparable CB studies identified from a systematic literature review were pooled. Prognostic variables for adjustment were ranked a priori by several practicing electrophysiologists. In the absence of a common treatment arm between the Ablation Index and CB studies, an unanchored MAIC was conducted. Primary analysis compared the Solimene et al. study to pooled CB studies. A secondary analysis compared pooled RF ablation with Ablation Index studies to pooled CB studies. Several scenario and sensitivity analyses were conducted.ResultsPrimary analyses showed statistically significant reductions in the rate of arrhythmia recurrence with RF ablation with Ablation Index compared to CB in unmatched, unadjusted (HR 0.50, 95% CI 0.27-0.95) and matched (0.42, 0.21-0.86) analyses. Greater reductions in the rate of arrhythmia recurrence that favored RF ablation with Ablation Index were observed after matching and adjusting for age (0.41, 0.20-0.85), age and left ventricular ejection fraction (0.37, 0.16-0.88), and age, sex, and left ventricular ejection fraction (0.30, 0.13-0.71). Secondary and sensitivity analyses showed similar reductions.ConclusionsRadiofrequency ablation with Ablation Index was associated with reductions in recurrence of atrial arrhythmias at 12 months compared to CB in unmatched and unadjusted, matched, and matched and adjusted comparisons.

Project description:Catheter ablation is a curative therapeutic approach for atrial fibrillation (AF). Ablation of rotational sources based on basket catheter measurements has been proposed as a promising approach in patients with persistent AF to complement pulmonary vein isolation. However, clinically reported success rates are equivocal calling for a mechanistic investigation under controlled conditions. We present a computational framework to benchmark ablation strategies considering the whole cycle from excitation propagation to electrogram acquisition and processing to virtual therapy. Fibrillation was induced in a patient-specific 3D volumetric model of the left atrium, which was homogeneously remodeled to sustain reentry. The resulting extracellular potential field was sampled using models of grid catheters as well as realistically deformed basket catheters considering the specific atrial anatomy. The virtual electrograms were processed to compute phase singularity density maps to target rotor tips with up to three circular ablations. Stable rotors were successfully induced in different regions of the homogeneously remodeled atrium showing that rotors are not constrained to unique anatomical structures or locations. Density maps of rotor tip trajectories correctly identified and located the rotors (deviation < 10 mm) based on catheter recordings only for sufficient resolution (inter-electrode distance ≤3 mm) and proximity to the wall (≤10 mm). Targeting rotor sites with ablation did not stop reentries in the homogeneously remodeled atria independent from lesion size (1-7 mm radius), from linearly connecting lesions with anatomical obstacles, and from the number of rotors targeted sequentially (≤3). Our results show that phase maps derived from intracardiac electrograms can be a powerful tool to map atrial activation patterns, yet they can also be misleading due to inaccurate localization of the rotor tip depending on electrode resolution and distance to the wall. This should be considered to avoid ablating regions that are in fact free of rotor sources of AF. In our experience, ablation of rotor sites was not successful to stop fibrillation. Our comprehensive simulation framework provides the means to holistically benchmark ablation strategies in silico under consideration of all steps involved in electrogram-based therapy and, in future, could be used to study more heterogeneously remodeled disease states as well.

Dataset Information

Comparison of the efficacy between impedance-guided and contact force-guided atrial fibrillation ablation using an automated annotation system.

Publications

Comparison of the efficacy between impedance-guided and contact force-guided atrial fibrillation ablation using an automated annotation system.

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