Abstract 16770: The Road to Durable Pulmonary Vein Isolation by Means of Radiofrequency Ablation Annotation Algorithm
Background: Recurrence of atrial fibrillation (AF) after catheter ablation by means of circumferential pulmonary vein isolation (CPVI) is common and often related to the recovery of conduction pulmonary vein (PV) and left atrium (LA) following an initially successful CPVI. The ablation annotation system (CARTO3 System, VISITAG Module,) uses an algorithm for the automated annotation of RF ablation applications based on objective, predefined parameters. It could be helpful in accomplishing durable CPVI for AF.
Objective: The objective of this study was to compare procedure parameters and outcomes between VISITAG-guided and non-guided CPVI.
Methods: We include in this study 93 AF patients underwent CPVI. All ablations were performed by single operator using ThermoCool SmartTouch catheter. In 51 patients (group A, paroxysmal AF 29/51:56.8%), RF ablation was guided by an automated algorithm with predefined criteria of catheter stability range of motion ≤ 1.5mm ,catheter stability duration >5 seconds, and force over time (contact force≧5g, time≧25%). When this condition is satisfied, new tag appears. Tag diameter was 6mm and we intended to move catheter to next position to appear the new tag where was overlapped with the former tag. When force time integral (FTI) of the tag becomes 100-150gs, the color of tag changed from white to red and we moved catheter to the next position. In 42 control patients (group B, paroxysmal AF 30/42:71.4%), ablations were performed by contact force guided ablation without automated algorithm.
Results: CPVI at the initial anatomical line was achieved more often in group A than in group B (66.7% vs 36.9%; P=0.001). The frequency of time dependent conduction recovery was lower in group A (14 of 102 pairs of PVs [13.7%]) than in group B (26 of 84 pairs of PVs [30.9%] ; P=0.0055). During 6-month follow up with 3 month blanking period, 94.1% patients in group A and 76.2% patients in group B were free from any atrial tachyarrhythmias (P=0.019).
Conclusion: In CPVI, automated ablation lesion annotation by optimal settings was effective in reducing the acute resumption of LA-PV conduction. Better durability of CPVI may improve long-term outcomes.
Author Disclosures: N. Tanaka: None. K. Inoue: None. K. Tanaka: None. Y. Toyoshima: None. T. Oka: None. M. Okada: None. A. Okamura: None. Y. Koyama: None. K. Iwakura: None. K. Fujii: None.
- © 2015 by American Heart Association, Inc.