A multicentered evaluation of ablation at higher power guided by ablation index: Establishing ablation targets for pulmonary vein isolation

Dhillon, Gurpreet; Ahsan, Syed; Honarbakhsh, Shohreh; Lim, Wei Yao; Bacà, Marco; Graham, Aaron; Srinivasan, Neil; Sawhney, Vinit; Sporton, Simon; Schilling, Richard J.; Chow, Anthony; Ginks, Matthew; Sohal, Manav; Gallagher, Mark M.; Hunter, Ross J.

doi:10.1111/jce.13813

Cited by 91 publications

(144 citation statements)

References 31 publications

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“…Few data were reported on the clinical outcome of AI‐guided HP RF application in AF ablation. Recently, the proportion of patients free from atrial tachyarrhythmia recurrence after AF ablation with AI‐guided HP RF application (30 W on posterior walls and 40 W elsewhere) was reported to be higher compared with the FTI‐guided conventional setting (25 W posterior wall and 30 W elsewhere) . But no data on the clinical impact of HP and short‐duration RF application compared with LP and long‐duration RF application with same target AI has been shown.…”

Section: Discussionmentioning

confidence: 99%

“…14 from atrial tachyarrhythmia recurrence after AF ablation with AIguided HP RF application (30 W on posterior walls and 40 W elsewhere) was reported to be higher compared with the FTI-guided conventional setting (25 W posterior wall and 30 W elsewhere). 13 But no data on the clinical impact of HP and short-duration RF application compared with LP and long-duration RF application with same target AI has been shown. Although a follow-up period was relatively short in this study (median 10.1 months in LP and MP and 6.5 in HP groups), we found no significant difference in AF-free survival rates among the three groups.…”

Section: Complicationsmentioning

confidence: 99%

“…Theoretically, AI‐guided HP RF application can create similar RF lesions for a short duration without excessive RF application. Recently, AI‐guided HP RF application (30‐40 W) was reported to complete CPVI with reduced acute PV reconnection, shorter procedure time and without increasing complication as compared with FTI‐guided CPVI with conventional RF application power (25‐30 W) . However, the procedural impact of HP RF application as compared with low‐power (LP) RF application with the same target AI was not fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

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High‐power application is associated with shorter procedure time and higher rate of first‐pass pulmonary vein isolation in ablation index‐guided atrial fibrillation ablation

Okamatsu

Koyama

Sakai

et al. 2019

Cardiovasc electrophysiol

107

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Backgrounds Ablation index (AI) is useful to complete circumferential pulmonary vein isolation (CPVI) for atrial fibrillation (AF), but the role of radiofrequency power in AI‐guided CPVI remains to be elucidated. Methods We investigated 60 patients with AF undergoing AI‐guided CPVI (mean age, 66 ± 9 years; nonparoxysmal AF in 16). The first 40 patients were randomly assigned to low‐power (LP; n = 20) and medium‐power (MP; n = 20) groups and the following 20 patients to high‐power (HP). In LP, radiofrequency (RF) application was done at 30 W at the anterior and 20 W at the posterior left atrial (LA) wall, while in MP, it was at 40 W at the anterior and 30 W at the posterior LA wall. In HP, 50 W was applied at the anterior, 40 W at posterior LA wall and 30 W on the esophagus. At each ablation point, target AI was 400 at the anterior, 360 at the posterior LA wall, and 260 on the esophagus. Results The time to complete both‐side CPVI was shortest in HP (median, 40 minutes, interquartile range [IQR], 28‐63) followed by MP (58 [49‐83] minutes, P = .008 vs HP) and LP (84 [72‐93] minutes, P = .002 vs MP). Higher RF power application significantly increased first‐pass isolation rate (55% in LP, 80% in MP and 85% in HP, P = .002) and decreased LA‐PV reconnection rate (10% in LP, 8% in MP, and 0% in HP, P = .03). Conclusion In AI‐guided PVI, the HP RF application can shorten the time to complete PVI with a high rate of first‐pass isolation and a low rate of LA‐PV reconnection.

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Section: Discussionmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High‐power application is associated with shorter procedure time and higher rate of first‐pass pulmonary vein isolation in ablation index‐guided atrial fibrillation ablation

Okamatsu

Koyama

Sakai

et al. 2019

Cardiovasc electrophysiol

107

View full text Add to dashboard Cite

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“…They found that HPSD using STSFc is safe and led to shorter procedure times with a reduced acute PV reconnection as compared to conventional ablation. 35 Thus, the safe and efficacious application of HPSD using STSFc as identified by more clinical trials, informs us that STSFc might be widely applied in the future for AF ablation.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of the ThermoCool SmartTouch SurroundFlow catheter for atrial fibrillation ablation: A meta‐analysis

Chen

Gao

Liu

et al. 2019

Clinical Cardiology

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Background The ThermoCool Smarttouch Surroundflow catheter (STSFc) is an advanced catheter, which integrating contact force sensing and surroundflow technology. However, comparative data between STSFc and contact force sensing catheter (Thermocool SmartTouch catheter [STc]) are limited. Hypothesis We thought that STSFc might bring more clinical benefits. The aim of this meta‐analysis was to compare the safety and efficiency between the STSFc and the STc for treatment of atrial fibrillation (AF). Methods The Medline, PubMed, Embase, and Cochrane Library databases were searched for studies comparing STSFc and STc. Results Four trials involving 727 patients were included in the study. Pool‐analyses demonstrated that, as compared STc ablation, STSFc ablation was more beneficial in terms of procedural times (standard mean difference [SMD]: −0.22; 95% confidence interval [CI], −0.37 to −0.07, P = .005) and irrigation fluid volume (SMD: −1.94; 95% CI, −2.65 to −1.22, P < .0001). There was no significant difference between STSFc and STc (risk ratio [RR]: 1.02; 95% CI: 0.86 to 1.21, P = .79) for free from AF. Evidence of complications were low and similar for both groups (RR: 0.83; 95% CI: 0.19‐3.55, P = .80). Additionally, patients administered STSFc ablation tended to have shorter fluoroscopic times (SMD: −0.20; 95% CI, −0.63‐0.23, P = .21). Conclusions STSFc ablation was associated with reducing procedural times and irrigation fluid volume. Further, STSFc ablation tended to shorten fluoroscopic times. Therefore, STSFc ablation would be a better choice for AF patients especially in patients with heart failure.

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“…4 Increased power theoretically results in reduced RF application duration when there is a similar CF. [5][6][7][8][9] However, the use of higher power could also potentially increase the complication rate, the risk of steam pop or esophageal injury. 10 While historically the power was set below 35 W (mostly ≤ 25 W at the posterior wall), 1,11,12 recent studies using AI as targeted endpoint have shown promising results with a power ≥35 W. 9,13,14 In all three of these studies, STSF catheters were used (SmartTouch Surround Flow;…”

Section: Introductionmentioning

confidence: 99%

Evaluation of higher power delivery during RF pulmonary vein isolation using optimized and contiguous lesions

Kyriakopoulou

Wielandts

Strisciuglio

et al. 2020

Cardiovasc electrophysiol

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Aims: "CLOSE"-guided pulmonary vein isolation (PVI) is based on contiguous (≤6 mm) and optimized radiofrequency (RF) ablation lesions (ablation index[AI] ≥ 400 posteriorly and ≥ 550 anteriorly]. However, the optimal RF power to reach the desired AI is unknown. Therefore we evaluated the efficiency of an ablation strategy using higher power (40 W) during a first "CLOSE"-guided PVI.Methods: Eighty consecutive patients undergoing "CLOSE"-guided PVI for symptomatic paroxysmal atrial fibrillation were ablated with 40 W (group A). Results were compared with 105 consecutive patients enrolled in the "CLOSE to CURE"-study and were ablated using the same protocol with 35 W (group B). Results:In group A, ablation was associated with shorter ablation procedure time (91 vs 111 minutes; P < .001), shorter fluoroscopy time (5 vs 11 minutes; P < .001), shorter PVI time (48 vs 64 minutes; P < .001), shorter RF time (20 vs 28 minutes; P < .001), lower RF time per application (22 vs 29 seconds; P < .001), less RF applications (52 vs 58; P < .001), and less catheter dislocations (1 vs 2; P = .002). The impedance drop (12 vs 13 Ω; P = .192), first-pass isolation rate (99% vs 93%; P = .141) and acute reconnection rate (6% vs 4%; P > .733) were similar in both groups (groups A and B, respectively). No complications occurred. In group A, a gastroscopy-performed in five patients with esophageal temperature rise more than 42°C-did not reveal any esophageal lesion. Postprocedural recurrence of atrial tachyarrhythmia at 1 year was not significantly different between both groups.Conclusions: Using the "CLOSE"-protocol, increased power increases the efficiency of PVI without compromising patients' safety. K E Y W O R D S atrial fibrillation, contact force, high power ablation, pulmonary vein isolation Maria Kyriakopoulou and Jean-Yves Wielandts contributed equally to this study. a Adenosine test performed in 97 out of 105 patients. F I G U R E 1 Two representative examples of "CLOSE"-guided encirclement of the pulmonary veins (PV) and the radiofrequency parameters (median/median value) of all VISITAG points in one patient from group A (40 W; A) and one patient from group B (35 W; B). Posteroanterior view. Red VISITAG points with ablation index (AI) > 550 and pink VISITAG points with AI > 400. Asterisk (*) on two dislocation points in group B (35 W) 1094 | KYRIAKOPOULOU ET AL.

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A multicentered evaluation of ablation at higher power guided by ablation index: Establishing ablation targets for pulmonary vein isolation

Cited by 91 publications

References 31 publications

High‐power application is associated with shorter procedure time and higher rate of first‐pass pulmonary vein isolation in ablation index‐guided atrial fibrillation ablation

High‐power application is associated with shorter procedure time and higher rate of first‐pass pulmonary vein isolation in ablation index‐guided atrial fibrillation ablation

Safety and efficacy of the ThermoCool SmartTouch SurroundFlow catheter for atrial fibrillation ablation: A meta‐analysis

Evaluation of higher power delivery during RF pulmonary vein isolation using optimized and contiguous lesions

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