Lesion Index–guided workflow for the treatment of paroxysmal atrial fibrillation is safe and effective – Final results from the LSI Workflow Study

Prasad, Karthik Venkatesh; Bonso, Aldo; Woods, Christopher; Goya, Masahiko; Matsuo, Seiichiro; Padanilam, Benzy J.; Kreis, Ingo; Yang, Felix; Williams, Colin J.; Tranter, John H.; Verbick, Laura Zitella; Sarver, Anne E.; Almendral, Jesús

doi:10.1016/j.hroo.2022.06.004

Cited by 7 publications

(2 citation statements)

References 14 publications

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“…Adoption of an LSI of 5.0 for ablation points is associated with higher PV isolation and higher sinus rhythm (SR) rates at 1 year since it provides a more uniform lesion delivery. 10,11 The aim of this study, using the high-power short-duration (HPSD) ablation, was to exame the lesion metrics LSI and local impedance drop (LID) measurements in adjusted weight HFLTV with RAP in comparison to standard ventilation (SV) and SR.…”

Section: Introductionmentioning

confidence: 99%

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Impact of weight adjusted high frequency low tidal volume ventilation and atrial pacing in lesion metrics in high‐power short‐duration ablation: Results of a pilot study

Vassallo,

Volponi,

Cunha

et al. 2024

Cardiovasc electrophysiol

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IntroductionLesion size index (LSI) was introduced with the use of Tacticath™ and as a surrogate of lesion quality. The metric used to achieve the predetermined values involves combined information of contact force (CF), power and radiofrequency time. Rapid atrial pacing (RAP) and high‐frequency low‐tidal volume ventilation (HFLTV) independently or in combination improve catheter stability and CF and quality of lesions. Data of the impact of body weight adjusted HFLTV ventilation strategy associated with RAP in the lesion metrics still lacking. The study aimed to compare the results of high‐power short‐duration (HPSD) atrial fibrillation ablation using simultaneous weight adjusted HFLTV and RAP and standard ventilation (SV) protocol.MethodsProspective, nonrandomized study with 136 patients undergoing de novo ablation divided into two groups; 70 in RAP (100 ppm) + HFLTV with 4 mL/kg of tidal volume and 25 breaths/min (group A) and 66 patients with SV in intrinsic sinus rhythm (group B). Ablation using 50 W, CF of 5–10 g/10–20 g and 40 mL/minute flow rate on the posterior and anterior left atrial wall, respectively.ResultsNo procedure‐related complications. Group A: Mean LSI points 70 ± 16.5, mean total lower LSI 3.4 ± 0.5, mean total higher LSI 8.2 ± 0.4 and mean total LSI 5.6 ± 0.6. Anterior and posterior wall mean total LSI was 6.0 ± 0.4 and 4.2 ± 0.3, respectively. Mean local impedance drop (LID) points were 118.8 ± 28.4, mean LID index (%) 12.9 ± 1.5, and mean LID < 12% points 55.9 ± 23.8. Anterior and posterior wall mean total LID index were 13.6 ± 2.0 and 11.9 ± 1.7, respectively. Recurrence in 11 (15.7%) patients. Group B: Mean LSI points 56 ± 2.7, mean total lower LSI 2.9 ± 0.7, mean total higher LSI 6.9 ± 0.9, and mean total LSI 4.8 ± 0.8. Anterior and posterior wall mean total LSI was 5.1 ± 0.3 and 3.5 ± 0.5, respectively. Mean LID points were 111.4 ± 21.5, mean LID index (%) 11.4 ± 1.2, and mean LID < 12% points 54.9 ± 25.2. Anterior and posterior wall mean total LID index were 11.8 ± 1.9 and 10.3 ± 1.7, respectively. Recurrence in 14 (21.2%) patients. Mean follow up was 15.2 ± 4.4 months.ConclusionWeight adjusted HFLTV ventilation with RAP HPSD ablation produced lower recurrence rate and better LSI and LID parameters in comparison to SV and intrinsic sinus rhythm.

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Section: Introductionmentioning

confidence: 99%

“…It can be monitored in real‐time during the procedure, and it can be used to guide the ablation therapy as it can predict the ablation lesion size. Adoption of an LSI of 5.0 for ablation points is associated with higher PV isolation and higher sinus rhythm (SR) rates at 1 year since it provides a more uniform lesion delivery 10,11 …”

Section: Introductionmentioning

confidence: 99%

Impact of weight adjusted high frequency low tidal volume ventilation and atrial pacing in lesion metrics in high‐power short‐duration ablation: Results of a pilot study

Vassallo,

Volponi,

Cunha

et al. 2024

Cardiovasc electrophysiol

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Influence of the irrigation flow pattern and catheter tip design on the lesion formation: an ex vivo experimental model

Kuroda,

Takeo,

Kobayashi

et al. 2023

J Interv Card Electrophysiol

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Local impedance drop–guided versus lesion size index–guided pulmonary vein isolation

Lian,

Pantlik,

Maslova

et al. 2024

J Interv Card Electrophysiol

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Background Local tissue impedance drop (LID) and lesion size index (LSI) technologies are valuable for predicting effective lesion formation. This study compares the acute and long-term efficacy of LID-guided versus LSI-guided pulmonary vein isolation (PVI) for atrial fibrillation treatment. Methods We retrospectively analyzed two patient groups undergoing radiofrequency PVI. In the LID-guided group (n = 35), ablation was performed without contact force monitoring, stopping at the LID plateau (target LID 12 Ohm posterior, 16 Ohm anterior). In the LSI-guided group (n = 31), ablation used contact force information with target LSI (5 anterior, 4 posterior). Both groups utilized a power of 40 W anterior and 30 W posterior, with < 6 mm inter-lesion distance. Gap mapping and touch-up ablation were done if necessary. Results PVI was achieved with a significantly shorter ablation time in the LSI-guided group (25 min [21;31] vs 30 [27;35], p = 0.035). PV gaps were more frequent in the LID-guided group (74% vs 42%, p = 0.016). Over 11.5 ± 2.9 months follow-up, arrhythmia recurrence was higher in the LID-guided group (34.3% vs 16.1%, p = 0.037). A redo procedure performed in 10 (28.6%) patients in the LID-guided group and 3 (9.7%) in the LSI-guided group showed chronic PV reconnections in 7 out of 10 (70%) and 2 out of 3 (67%) patients, respectively. Conclusions LSI-guided ablation results in shorter ablation time and fewer PV gaps compared to LID-guided ablation. Despite initial success, LID-guided ablation had higher arrhythmia recurrence and PV reconnections during long-term follow-up compared to LSI-guided ablation. Graphical abstract

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Lesion Index–guided workflow for the treatment of paroxysmal atrial fibrillation is safe and effective – Final results from the LSI Workflow Study

Cited by 7 publications

References 14 publications

Impact of weight adjusted high frequency low tidal volume ventilation and atrial pacing in lesion metrics in high‐power short‐duration ablation: Results of a pilot study

Impact of weight adjusted high frequency low tidal volume ventilation and atrial pacing in lesion metrics in high‐power short‐duration ablation: Results of a pilot study

Influence of the irrigation flow pattern and catheter tip design on the lesion formation: an ex vivo experimental model

Local impedance drop–guided versus lesion size index–guided pulmonary vein isolation

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