Influence of ablation index on the incidence of cardiac tamponade complicating pulmonary vein isolation
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Nico Reinsch1,2 Kars Neven1,2
· Anna Füting1,2 · Jochen Buchholz3 · Ute Ruprecht1,2 ·
1
Department of Electrophysiology, Alfried Krupp Krankenhaus, Essen, Germany Witten/Herdecke University, Witten, Germany 3 Department of Cardiology, Evangelisches Krankenhaus Oberhausen, Oberhausen, Germany 2
Influence of ablation index on the incidence of cardiac tamponade complicating pulmonary vein isolation
Introduction
Methods
Catheter ablation of atrial fibrillation (AF) has evolved into an established and widespread treatment option in patients with symptomatic AF [1]. However, AF ablation remains a challenging procedure linked to possible life-threatening complications [2]. Cardiac tamponade (CT) following pulmonary vein (PV) isolation (PVI) is one of the most challenging complications with a potentially fatal outcome [3]. Therefore, strategies to minimize this complication are clearly warranted. Three-dimensional (3D) left atrial (LA) mapping and “point-bypoint” radiofrequency (RF) current energy ablation is the standard approach to achieve PVI. A variety of novel ablation tools have been introduced to facilitate this primary procedural endpoint. Two recent developments promise to improve procedural outcome of PVI based on RF ablation. First, catheter-to-tissue contact-force (CF) sensing technology confirms appropriate pressure by the ablation catheter to effectively facilitate RF energy transfer to the atrial myocardium [4, 5]. Second, ablation index (AI) is a novel ablation quality marker that incorporates CF, time, and power in a weighted formula [6]. The authors hypothesized that the use of AI reduces the incidence of periprocedural CT.
All AF ablation procedures performed at the Alfried Krupp Krankenhaus, Essen, Germany, between 10/2014 and 06/2019 were retrospectively analyzed from the center’s ablation registry. The Alfried Krupp Krankenhaus is a high-volume center with >400 PVIs in the last year. Prior to ablation, written informed consent was obtained from all patients. The principle outlined in the latest update of the Declaration of Helsinki was followed. The local ethical committee of the University Witten/Herdecke, Germany, approved this study(132/2020). All relevant baseline characteristics and procedural data, including ablation catheter, first or repeat procedure number, complications, and acute outcomes, were noted. Demographic, clinical, and echocardiographic data were entered in the database at the time of the procedure. Hypertension was defined as either blood pressure higher than 140/90 or a previously established diagnosis. Paroxysmal AF is defined as an episode of AF that terminates spontaneously or with intervention in less than 7 days. Left atrial diameter was categorized as a sex-specific variable, such that left atrial enlargement was defined as a left atrial diameter of 4.1 cm or greater in men or 3.9 cm or greater in women; a left atrial diameter below these values defined normal left atrial size. Left atrial enlargement was further classified as mild (left atrial diameter 4.1–4.6 cm
in men or 3
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