Optimal interlesion distance in ablation index-guided pulmonary vein isolation for atrial fibrillation
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Optimal interlesion distance in ablation index-guided pulmonary vein isolation for atrial fibrillation Shuhei Kobayashi 1 & Hidehira Fukaya 1 & Jun Oikawa 1 & Daiki Saito 1 & Tetsuro Sato 1 & Gen Matsuura 1 & Yuki Arakawa 1 & Yuki Shirakawa 1 & Ryo Nishinarita 1 & Ai Horiguchi 1 & Naruya Ishizue 1 & Jun Kishihara 1 & Shinichi Niwano 1 & Junya Ako 1 Received: 5 June 2020 / Accepted: 16 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Ablation index (AI) is a useful tool of the CARTO® system to make effective lesions during pulmonary vein isolation (PVI) for atrial fibrillation (AF). However, the optimal distance between neighboring ablation points (interlesion distance (ILD)) is still unclear. Here, we evaluated the optimal ILDs in the AI-guided PVI. Methods Forty-nine AF patients who underwent AI-guided PVI in our institute from July 2018 to March 2019 were retrospectively enrolled in this study. Target AI was set at 500 and 400 for anterior and posterior walls, respectively, and we compared the ILDs with and without electrical gaps after a first encircling PVI. Results In both PV, the ILDs with electrical gaps were longer than those without electrical gaps. The best cutoff values of ILD to detect the electrical gaps using the ROC curve were 5.4 mm for the RPV anterior wall (AUC, 0.67; sensitivity, 0.42; specificity, 0.84, P < 0.01) and 4.4 mm for the RPV posterior wall (AUC, 0.68; sensitivity, 0.91; specificity, 0.39, P < 0.01). Similarly, the best cutoff values of ILD were 5.5 mm for the LPV anterior wall (AUC, 0.74; sensitivity, 0.65; specificity, 0.82, P < 0.01) and 5.1 mm for the LPV posterior wall (AUC, 0.67; sensitivity, 0.79; specificity, 0.53, P =0.03). Conclusion The optimal interlesion distances for PVI were different in each PV segment. To achieve the first-pass isolation, less than 5.4/4.4 mm for the RPV anterior/posterior and 5.5/5.1 mm for the LPV anterior/posterior walls of interlesion distances were the best cutoff values in the patients with AF. Keywords Atrial fibrillation . Pulmonary vein isolation . Ablation index . Interlesion distance
1 Introduction Catheter ablation has recently merged as first-line therapy for atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the cornerstone of the procedure and it is important to make a durable PVI lesion to prevent AF recurrence [1–3]. In the conventional radiofrequency (RF) catheter ablation, the achievement of the effective lesion was Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10840-020-00881-0) contains supplementary material, which is available to authorized users. * Hidehira Fukaya [email protected] 1
Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
estimated by a decrease in local impedance during RF application and local signal amplitude, loss of pace seeing capture during RF delivery, and inability to pace after RF energy delivery [4–7]
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