Reproducibility of pulmonary vein isolation guided by the ablation index: 1‐year outcome of the AIR registry

Abstract

Background Ablation index (AI) is a new lesion quality marker that has been demonstrated to allow a high single‐procedure arrhythmia‐free survival in single‐center studies. This prospective, multi‐center study was designed to evaluate the reproducibility of pulmonary vein (PV) isolation guided by the AI. Methods A total of 490 consecutive patients with paroxysmal (80.4%) and persistent AF underwent first time PV isolation and were divided in four study groups according to operator's preference in choosing the ablation catheter (a contact force (ST) or contact force surround flow (STSF) catheter) and the AI setting (330‐450 or 380‐500 at anterior wall or posterior wall, respectively). Results At 12 months a high rate of freedom from AF recurrences was observed in patients with both paroxysmal and persistent AF (91% vs 83.3%; P = .039). There was no difference in the rate of AF recurrence among the four study groups (4.5% in group ST330‐450, 12.2% in group ST 380‐500, 14.9% in group STSF330‐450, 9.4% in group STSF380‐500; P = .083). Recurrence was also similar between patients treated with a ST (8%) or STSF catheter (12.1%; P = .2), and within patients targeting an AI settings of 330 to 450 (10.9%) or 380 to 500 (10.3%; P = .64). In patients with paroxysmal AF, there was no difference (P = .12) in the 1‐year freedom from AF recurrence among 14 operators that performed ≥10 ablation procedure. Conclusions An ablation protocol respecting strict criteria for contiguity and quality lesion resulted in high rate of 1‐year freedom from AF recurrence, irrespective of the ablation catheters, AI settings, and operator.

Pulmonary vein isolation in atrial fibrillation patients guided by a novel local impedance algorithm: 1‐year outcome from the CHARISMA study

“…Several observations testify to the reliability of the reported >90% single‐procedure freedom from paroxysmal AF after ‘CLOSE’‐guided PVI: avoiding weak links within the RF circle deployed is the key to durable PV isolation and clinical success 17–20 . Moreover, in a multicenter clinical practice setting, an ablation protocol that respected strict criteria for contiguity and the quality of lesions resulted in a high rate of 1‐year freedom from AF recurrence and a low complication rate, irrespective of the ablation catheters used and the AI settings 21,22 …”

Pulmonary vein isolation guided by moderate ablation index targets combined with strict procedural endpoints for patients with paroxysmal atrial fibrillation

“…Several other ongoing studies, including a multicenter trial, are evaluating the efficiency, safety, and efficacy of the CLOSE protocol 13,14 . A recent study, however, suggested that an AI value of 330 for the posterior and 450 for the anterior wall were as safe and reliable as higher values (380 for the posterior and 500 for the anterior wall) 15 …”

Effectiveness of Radiofrequency Catheter Ablation Using Ablation Index Versus Second Generation Cryoballoon in the Treatment of Persistent Atrial Fibrillation: A Matching-Adjusted Indirect Comparison

“…One of the STAI studies reported 67% (n = 21) of patients underwent cavotricuspid isthmus ablation or left atrial posterior wall ablation with a box lesion set [6]. One study reported 8% (n = 3) of patients received cavotricuspid isthmus ablation [7]; in the other study, one patient with PsAF received a posterior wall box lesion [12]. In contrast, three of the CB studies reported using a PVIonly approach [4,19,20], and one reported 7.9% (n = 8) of patients underwent right atrial flutter ablations using RF energy [18].…”

“…Individual patient-level data from four investigator-initiated studies on STAI that included patients with PsAF were available for analysis [6][7][8]12]. The first study by Hussein et al [6] was a prospective, single-arm registry that included 40 PsAF patients.…”

“…The study by Solimene et al [8] was a prospective, single-arm registry that included 32 PsAF patients treated with STAI. Finally, the study by Stabile et al [12] was also a prospective registry, and included 96 PsAF patients treated with STAI. Across all four studies, a total of 191 PsAF patients treated with STAI were available for analysis.…”