Prospective use of ablation index for the ablation of right ventricle outflow tract premature ventricular contractions: a proof of concept study. Issue 1 (16th October 2020)

• Record Type: Journal Article
• Authors: Gasperetti, Alessio; Sicuso, Rita; Dello Russo, Antonio; Zucchelli, Giulio; Saguner, Ardan Muammer; Notarstefano, Pasquale; Soldati, Ezio; Bongiorni, Maria Grazia; Della Rocca, Domenico Giovanni; Mohanty, Sanghamitra; Carbucicchio, Corrado; Duru, Firat; Di Biase, Luigi; Natale, Andrea; Tondo, Claudio; Casella, Michela
• Is Part Of: Europace. Volume 23:Issue 1(2021)
• Page Start: 91
• Page End: 98
• Publication Date: 2020-10-16
• Subjects: Idiopathic premature ventricular contractions -- Catheter ablation -- Ventricular arrhythmias -- Right ventricle outflow tract -- Ablation index; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euaa228
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Radiofrequency catheter ablation (RFCA) represents an effective option for idiopathic premature ventricular contractions (PVCs) treatment. Ablation Index (AI) is a novel ablation marker incorporating RF power, contact force, and time of delivery into a single weighted formula. Data regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was to compare AI-guided and standard RFCA outcomes in patients with PVCs originating from the right ventricle outflow tract (RVOT). Methods and results: Consecutive patients undergoing AI-guided RFCA of RVOT idiopathic PVCs were prospectively enrolled. Radiofrequency catheter ablation was performed following per-protocol target cut-offs of AI, depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI cut-off: 610). A multi-centre cohort of propensity-matched (age, sex, ejection fraction, and PVC site) patients undergoing standard PVCs RFCA was used as a comparator. Sixty AI-guided patients (44.2 ± 18.0 years old, 58% male, left ventricular ejection fraction 56.2 ± 3.8%) were enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in the RVOT free wall area. Propensity match with 60 non-AI-guided patients was performed. Acute outcomes and complications resulted comparable. At 6 months, arrhythmic recurrence was more common in non-AI-guided patients whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation Index guidance was associated with improved survival from arrhythmic recurrence [overall odds ratio 6.61 (1.95–22.35), P = 0.001; RVOT septum 5.99 (1.21–29.65), P = 0.028; RVOT free wall 11.86 (1.12–124.78), P = 0.039]. Conclusion: Ablation Index-guidance in idiopathic PVCs ablation was associated with better arrhythmic outcomes at 6 months of follow-up.