Radiofrequency pulmonary vein isolation using catheter dragging technique guided by grid annotation vs. point-by-point technique guided by Ablation Index: a randomized controlled trial. (14th October 2021)

• Record Type: Journal Article
• Authors: Mulder, M.J; Kemme, M.J.B; Hopman, L.H.G.A; Hagen, A.M.D; Van De Ven, P.M; Hauer, H.A; Tahapary, G.J.M; Van Rossum, A.C; Allaart, C.P
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Rhythm Control, Catheter Ablation; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.0506
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Pulmonary vein isolation (PVI) with radiofrequency (RF) ablation is an important treatment option in symptomatic atrial fibrillation (AF) patients. Ablation Index (AI) has recently attracted considerable interest as a guide for PVI procedures and combines contact force, RF application time and ablation power into a single metric. A limitation of ablation strategies guided by AI is the impossibility to use a catheter dragging technique. Although comparative studies are sparse, ablation using a catheter dragging technique may shorten procedural duration and improve PVI durability by creating uninterrupted linear ablation lesions. These ablation lesions can be visualized by a grid (grid annotation), which may provide valuable information on both lesion depth and lesion contiguity. We compared an AF ablation approach guided by grid annotation, with a point-by-point AI annotation approach in a single-center randomized study. Methods: Eighty-eight patients with paroxysmal or persistent AF were randomized 1:1 to undergo RF-PVI guided by either grid annotation or AI annotation. In the grid annotation arm, ablation was visualized using automatic generation of 1mm 3 grid points projected on the electroanatomic map, with grid points coloring red after 15 seconds of ablation while meeting predefined stability and contact force criteria. Ablation was performed aiming for a continuous circle of red grid points. In the AI annotation arm, ablation was visualized using automatically generated lesion tags with a diameter of 3 mm. AI target values were set at 380 and 500 for posterior/inferior and anterior/roof segments, respectively. Ablation lesions were created in a point-by-point fashion, aiming for a maximum interlesion distance of 6 mm. All study participants were followed up for 12 months after PVI using out-patient clinic visits, ECGs, 24-hour Holter monitoring and a mobile-based one-lead ECG device to assess heart rhythm when symptoms suggestive of an arrhythmia occurred. Results: The primary endpoint of procedure time was not different between the two randomization arms (grid annotation 71±19 min, AI annotation 72±26 min, p=0.765, Figure 1A). RF time was significantly longer in the grid annotation arm compared with the AI annotation arm (49±8 min vs. 37±8 min, respectively, p<0.001). Neither fluoroscopy time or radiation dose were different between the randomization arms. All patients completed 12 months of follow-up and recurrent atrial tachyarrhythmias were observed in 29 patients (33%). Recurrence of any atrial tachyarrhythmia was documented in 10 patients (23%) in the grid annotation arm compared with 19 patients (42%) in the AI annotation arm, which did not reach statistical significance by log-rank test (p=0.074, Figure 1B). Conclusions: Findings from this randomized controlled study suggest that grid annotation may provide an alternative approach for RF-PVI using AI, allowing for ablation with the catheter dragging technique. Funding Acknowledgement: Type of funding sources: Private company. Main funding source(s): Biosense Webster, Inc.