The effect of left atrial wall thickness and pulmonary vein sizes on the acute procedural success of atrial fibrillation ablation

Abstract

Nowadays, a novel contact-force guided ablation technique is used for enclosing pulmonary veins in patients with atrial fibrillation (AF). We sought to determine whether left atrial (LA) wall thickness (LAWT) and pulmonary vein (PV) dimensions, as assessed by cardiac CT, could influence the success rate of first-pass pulmonary vein isolation (PVI). In a single-center, prospective study, we enrolled consecutive patients with symptomatic, drug-refractory AF who underwent initial radiofrequency catheter ablation using a modified CLOSE protocol. Pre-procedural CT was performed in all cases. Additionally, the diameter and area of the PV orifices were obtained. A total of 1034 LAWT measurements and 376 PV area measurements were performed in 94 patients (mean CHA2DS2-VASc score 2.1 ± 1.5, mean age 62.4 ± 12.6 years, 39.5% female, 38.3% persistent AF). Mean procedure time was 81.2 ± 19.3 min. Complete isolation of all PVs was achieved in 100% of patients. First-pass isolation rate was 76% and 71% for the right-sided PVs and the left-sided PVs, respectively. No difference was found regarding comorbidities and imaging parameters between those with and without first-pass isolation. LAWT (mean of 11 regions or separately) had no effect on the acute procedural outcome on logistic regression analysis (all p ≥ 0.05). Out of all assessed parameters, only RSPV diameter was associated with a higher rate of successful right-sided first pass isolation (OR 1.01, p = 0.04). Left atrial wall thickness does not have an influence on the acute procedural success of PVI using ablation index and a standardized ablation protocol. RSPV diameter could influence the probability of right sided first-pass isolation.

Network meta‐analysis and systematic review comparing efficacy and safety between very high power short duration, high power short duration, and conventional radiofrequency ablation of atrial fibrillation

“… The first‐pass isolation (FPI) rate was defined as the presence of the entrance and exit block of the PV after completing a first circumferential ablation in all four PVs 12 Total procedure time. Rate of major complications including cardiac tamponade/pericardial effusion, PV stenosis, thromboembolism, groin bleeding required transfusion, phrenic nerve paralysis, and atrioesophageal fistula 13 …”

“…(2) The first-pass isolation (FPI) rate was defined as the presence of the entrance and exit block of the PV after completing a first circumferential ablation in all four PVs. 12 (3) Total procedure time.…”

Atrial fibrillation ablation: the position of computed tomography in pre-procedural imaging

“…In the recently published study by Boussoussou et al, the authors revealed that RSPV diameter is associated with a higher rate of successful right-sided first-pass isolation [73]. Additionally, according to another recent paper, only the larger LA volume index and variant PVs anatomy are independently associated with increased risk of AF recurrence [74].…”

High-Power, Short-Duration Ablation under the Guidance of Relatively Low Ablation Index Values for Paroxysmal Atrial Fibrillation: Long-Term Outcomes and Characteristics of Recurrent Atrial Arrhythmias

“…A local impedance drop more than 21.80 ohms on the anterior wall and more than 18.30 ohms on the posterior wall significantly increased the probability of creating a successful lesion [26]. Boussoussou M et al [27] found that LA wall thickness did not influence the first-pass isolation rate during PVI guided by the modified CLOSE protocol (AI 400 on the posterior wall and 500 on the anterior wall, CF 10-40 g). Only the diameter of the right superior PV was associated with the success rate of right-sided first pass isolation, as a wider right superior PV diameter led to an easier first-pass isolation.…”