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Contact Force-Guided Ablation Reduced Poor Contact Segments and Improved Acute Reconnection in Patients with Atrial Fibrillation.

ABSTRACT: Background:There is a paucity of information regarding whether contact force (CF)-guided ablation improves the outcomes of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) by achieving more optimal contact. We sought to assess whether real time CF-guided ablation has an impact on ablation parameters and acute pulmonary vein reconnection (PVR). Methods:Left or right PVs were randomized to either CF-guided or blinded groups, and the order of CF blindness: CF-guided left PV/CF-blinded right PV, CF-blinded left PV/CF-guided right PV, CF-guided right PV/CF-blinded left PV, and CF-blinded right PV/CF-guided left PV groups. We compared CF parameters and acute PVR between segments ablated by CF-guided and CF-blinded strategies. Results:Sixty patients with drug refractory symptomatic AF were included (paroxysmal AF 73%). CF-guided segments did not show significant differences in CF parameters compared to CF-blinded segments. However, CF-guided segments showed fewer segments with mean CF value <5 g than CF-blinded segments (4.3% vs. 12.4%, p<0.001). Forty-two patients showed acute PVR in 92 segments (8.5%). CF-guided PV segments showed lower acute PVR rate than CF-blinded segments (5.9% vs. 11.1%, p=0.011). Conclusions:CF-guided ablation could reduce acute PVR after PVI by decreasing the number of segments with poor contact rather than increasing the mean CF during ablation. Better contact guided by CF information might help in improving the results of PVI. Further investigation will be needed to identify the association between the difference in acute reconnection and the long-term outcomes.

SUBMITTER: So-Ryoung L

PROVIDER: S-EPMC7237089 | biostudies-literature | 2020 Feb-Mar

REPOSITORIES: biostudies-literature

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Contact Force-Guided Ablation Reduced Poor Contact Segments and Improved Acute Reconnection in Patients with Atrial Fibrillation.

So-Ryoung Lee L Hyoung-Seob Park P Eue-Keun Choi C Soonil Kwon K Youngjin Cho C Il-Young Oh O Seil Oh O Seongwook Han H

Journal of atrial fibrillation 20200228 5

<h4>Background</h4>There is a paucity of information regarding whether contact force (CF)-guided ablation improves the outcomes of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) by achieving more optimal contact. We sought to assess whether real time CF-guided ablation has an impact on ablation parameters and acute pulmonary vein reconnection (PVR).<h4>Methods</h4>Left or right PVs were randomized to either CF-guided or blinded groups, and the order of CF blindness: CF- ...[more]

PMID: 32435352

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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.

Dataset Information

Contact Force-Guided Ablation Reduced Poor Contact Segments and Improved Acute Reconnection in Patients with Atrial Fibrillation.

Publications

Contact Force-Guided Ablation Reduced Poor Contact Segments and Improved Acute Reconnection in Patients with Atrial Fibrillation.

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