Modified ablation index: a novel determinant of a successful first-pass left atrial posterior wall isolation

Hayashida, Satoshi; Nagashima, Koichi; Kurokawa, Syuhei; Arai, M.; Watanabe, Ryuta; Wakamatsu, Yuji; Otsuka, Naoto; Yagyu, Seina; Iso, Kazuki; Okumura, Yasuo

doi:10.1007/s00380-021-01971-3

Cited by 3 publications

(6 citation statements)

References 24 publications

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“…21 A recent study suggested a modified AI ≥ 199 au/mV (AI/bipolar voltage along the ablation line) for successful left atrial posterior wall isolation. 22 In our study, AI ≥ 500 for the anterior and roof segments and AI ≥ 400 for posterior, carina, and inferior segments reduced the acute PV reconnection in those with LAWT grade ≥3 (≥1.5 mm).…”

Section: Discussionsupporting

confidence: 49%

“…In this small randomized clinical trial, compared with conventional force‐time integral guided PVI ( n = 40), tailored AI PVI ( n = 40) achieved higher first‐pass isolation, decreased RP, decreased time to complete PVI, and a higher 1‐year AF‐free survival rate 21 . A recent study suggested a modified AI ≥ 199 au/mV (AI/bipolar voltage along the ablation line) for successful left atrial posterior wall isolation 22 . In our study, AI ≥ 500 for the anterior and roof segments and AI ≥ 400 for posterior, carina, and inferior segments reduced the acute PV reconnection in those with LAWT grade ≥3 (≥1.5 mm).…”

Section: Discussionmentioning

confidence: 99%

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Tailored ablation index based on left atrial wall thickness assessed by computed tomography for pulmonary vein isolation in patients with atrial fibrillation

Lee,

Park,

Kwon

et al. 2023

Cardiovasc electrophysiol

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IntroductionAlthough left atrial wall thickness (LAWT) is known to be varied, a fixed target Ablation Index (AI) based pulmonary vein isolation (PVI) has been suggested in catheter ablation for atrial fibrillation (AF). We aimed to evaluate the efficacy and safety of PVI applying tailored AI based on LAWT assessed by cardiac computed tomography (CT).MethodsThe thick segment was defined as the segment including ≥LAWT grade 3 (≥1.5 mm). The fixed AI strategy was defined as AI targets were 450 on the anterior/roof segments and 350 on the posterior/inferior/carina segments regardless of LAWT. The tailored AI strategy consisted of AI increasing the targets to 500 on the anterior/roof segments and to 400 on the posterior/inferior/carina segments when ablating the thick segment. After PVI, acute pulmonary vein (PV) reconnection, defined by the composite of residual potential and early reconnection, was evaluated.ResultsA total of 156 patients (paroxysmal AF 72%) were consecutively included (86 for the fixed AI group and 70 for the tailored AI group). The tailored AI group showed a significantly lower rate of segments with acute PV reconnection than the fixed AI group (8% vs. 5%, p = .007). The tailored AI group showed a trend for shorter ablation time for PVI. One‐year AF/atrial tachycardia free survival rate was similar in two groups (87.2% in the fixed AI group and 90.0% in the tailored AI group, p = .606).ConclusionApplying tailored AI based on the LAWT was a feasible and effective strategy to reduce acute PV reconnection after PVI.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Tailored ablation index based on left atrial wall thickness assessed by computed tomography for pulmonary vein isolation in patients with atrial fibrillation

Lee,

Park,

Kwon

et al. 2023

Cardiovasc electrophysiol

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“…Although our wall thickness cut‐off of ≥2.3 mm was slightly shallower, it can be considered reasonable when taking into account the complex anatomical structures and the impact of respirations and cardiac movements during clinical ablation procedures. Additionally, our group conducted similar evaluations with a different multispline mapping catheter (Penta‐Ray NAV; Biosense Webster) for the cut‐off values of the voltages on the posterior wall lines created using an AI‐guided ablation with a 3.5‐mm open‐irrigated‐tip SmartTouch catheter (power: 45 W [25–35 W when the esophageal temperature rose], target CF > 10 g, target AI: 400–450, ILD < 6 mm) 13 . We also evaluated the voltages on the PVI line (power: 25–30 W, target CF > 10 g, FTI > 400 gs, ILD <6 mm) 8,11 .…”

Section: Discussionmentioning

confidence: 99%

“…400-450, ILD < 6 mm). 13 We also evaluated the voltages on the PVI line (power: 25-30 W, target CF > 10 g, FTI > 400 gs, ILD <6 mm). 8,11 Those evaluations identified cut-off values of ≥2.64 mV for the voltages to predict failure sites on the posterior wall lines and a voltage cut-off of ≥2.69 mV for PVI failure sites.…”

Section: Ablation Outcomes On the Chronic Phasementioning

confidence: 99%

“…Therefore, the different ablation settings resulted in slightly higher voltage cut-off values, however, different mapping catheter validations would be needed, 14 suggesting there would be similar or shallower lesions with the 90 W/4 s-vHPSD ablation as compared to the AI-guided 45 W-HPSD ablation or FTI-guided 25-30 W-standard power ablation. 8,11,13…”

Section: Ablation Outcomes On the Chronic Phasementioning

confidence: 99%

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Where is the gap after a 90 W/4 s very‐high‐power short‐duration ablation of atrial fibrillation?: Association with the left atrial‐pulmonary vein voltage and wall thickness

Hirata,

Nagashima,

Watanabe

et al. 2024

Journal of Arrhythmia

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BackgroundAlthough pulmonary vein isolation (PVI) for atrial fibrillation (AF) utilizing radiofrequency (RF) applications with a very high‐power and short‐duration (vHPSD) has shortened the procedure time, the determinants of pulmonary vein (PV) gaps in the first‐pass PVI and acute PV reconnections are unclear.MethodsAn extensive encircling PVI was performed with the QDOT MICRO catheter with a vHPSD (90 W–4 s) in 30 patients with AF (19 men, 64 ± 10 years). The association of the PV gap sites (first‐pass PVI failure, acute PV reconnections [spontaneous reconnections or dormant conduction provoked by adenosine triphosphate] or both) with the left atrial (LA) wall thickness and LA bipolar voltage on the PVI line and ablation‐related parameters were assessed.ResultsPV gaps were observed in 29 (6%) of 480 segments (16 segments per patient) in 17 patients (56%). The PV gaps were associated with the LA wall thickness, bipolar voltage, and the number of RF points (LA wall thickness, 2.5 ± 0.5 vs. 1.9 ± 0.4 mm, p < .001; bipolar voltage, 2.59 ± 1.62 vs. 1.34 ± 1.14 mV, p < .001; RF points, 6 ± 2 vs. 4 ± 2, p = .008) but were not with the other ablation‐related parameters. Receiver operating characteristic curves yielded that an LA wall thickness ≥2.3 mm and bipolar voltage ≥2.40 mV were determinants of PV gaps with an area under the curve of 0.82 and 0.73, respectively.ConclusionsThe LA voltage and wall thickness on the PV‐encircling ablation line were highly associated with PV gaps using the 90 W/4 s‐vHPSD ablation.

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Ablation Index Guided Left Atrial Posterior Wall Isolation

Makihara¹,

Miyazaki

Harama³

et al. 2022

Int. Heart J.

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Modified ablation index: a novel determinant of a successful first-pass left atrial posterior wall isolation

Cited by 3 publications

References 24 publications

Tailored ablation index based on left atrial wall thickness assessed by computed tomography for pulmonary vein isolation in patients with atrial fibrillation

Tailored ablation index based on left atrial wall thickness assessed by computed tomography for pulmonary vein isolation in patients with atrial fibrillation

Where is the gap after a 90 W/4 s very‐high‐power short‐duration ablation of atrial fibrillation?: Association with the left atrial‐pulmonary vein voltage and wall thickness

Ablation Index Guided Left Atrial Posterior Wall Isolation

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