Abstract 15805: Determination of Ideal Radiofrequency Delivery Parameters, and Areas With High Risk of Pulmonary Vein Reconnection in Patients With Atrial Fibrillation Undergoing Pulmonary Vein Antrum Isolation
Introduction: Pulmonary Vein Antral Isolation (PVI) for patients with Atrial Fibrillation (AF) refractory to medical therapy remains technically difficult with poor long term success rates. Algorithms objectifying radiofrequency energy (RF) delivery to enhance consistency of lesions have been shown to improve outcomes. Optimal settings for catheter stability and energy delivery duration have not been validated. This study aimed to elucidate the duration of optimal RF lesion delivery while maintaining maximum catheter stability to minimize the need for reablation during repeat procedures in patients with recurrent AF following PVAI.
Methods: Duration of ablation while maintaining catheter stability (DS) value (sec) for 380 ablation points from 10 patients (60% Male, Mean age: 67.3 years) who underwent redo ablation was collected. DS was obtained in a blinded fashion from ablation points demarcated by the CARTO 3 VisiTag™ algorithm in areas with local reconnection prompting ablation at the time of repeat PVAI. VisiTag™ settings for the first procedure were then manipulated to bring out areas which required repeat ablation at the time of the second PVAI. ROC analysis was used to determine the ideal DS setting associated with the lowest likelihood for repeat ablation in the same area at the time of the second PVAI while lowering the catheter stability setting to 2.5mm for all lesions.
Results: Overall, average RF delivery time per lesion was higher during the second PVAI than the initial procedure (18.8±8.6 sec vs. 11.1±5.91 sec, P=0.001). Furthermore, ROC analysis revealed 11.84 sec to be the ideal DS value with the area under curve of 0.848 (95%CI: 0.805-0.891, P<0.0001) and 82.5% sensitivity / 75.2% specificity, P<0.0001 (Figure1). The ridge between left superior PV and left atrial appendage, inferior to the right inferior PV, antero-inferior to the right inferior PV, and carina between right-sided PVs, were reconnected in 50%, 40%, 30%, and 30% of patients respectively.
Conclusion: Setting the Visitag™ algorithm to demarcate ablation lesions at 2.5 mm and 12 sec during PVAI should reduce or eliminate the need for repeat local ablation and may in turn result in a lower risk of recurrent AF following PVAI. This finding warrants prospective validation.
Author Disclosures: P. Alipour: None. Y. Khaykin: None. S. Conti: None. Z. Azizi: None. M. Pirbaglou: None. P. Ritvo: None. A. Pantano: None. A. Verma: None.
- © 2016 by American Heart Association, Inc.