The industrialization of ablation: a highly standardized and reproducible workflow for radiofrequency ablation of atrial
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The industrialization of ablation: a highly standardized and reproducible workflow for radiofrequency ablation of atrial fibrillation Tom De Potter 1 & Tina D. Hunter 2 & Lee Ming Boo 3 & Sofia Chatzikyriakou 1,4 & Teresa Strisciuglio 1,5 & Etel Silva 1 & Peter Geelen 1 Received: 14 March 2019 / Accepted: 6 September 2019 # The Author(s) 2019
Abstract Background or Purpose The purpose of this analysis was to report on efficacy of a standardized workflow for atrial fibrillation (AF) ablation using technology advances such as 3D imaging and contact force sensing in a real-world setting. Methods Consecutive AF ablations from 2014 to 2015 at a high-volume site in Belgium were included. The workflow consisted of a pre-specified procedure sequence including 3D modeling followed by radiofrequency encircling of the pulmonary veins (25 W posterior wall, 35 W anterior wall) with a THERMOCOOL SMARTTOUCH® Catheter guided by CARTO VISITAG™ Module (2.5 mm/5 s stability, 50% > 7 g) and ablation index (targets: 550 anterior wall, 400 posterior wall). Efficiency endpoints were procedure time, fluoroscopy time, and radiation dose. The primary effectiveness endpoint was freedom from atrial arrhythmia recurrence. Results A total of 605 paroxysmal AF (PAF) and 182 persistent AF (PsAF) patients were followed for 436 ± 199 days. Mean procedure times were short (PAF: 96.1 ± 26.2 min; PsAF: 109.2 ± 35.6 min) with most procedures (90.6% PAF; 81.3% PsAF) completed in ≤ 120 min. Minimal fluoroscopy was utilized (PAF: 6.1 ± 3.8 min, 5.9 ± 3.4 Gy*cm2; PsAF: 6.9 ± 4.7 min, 7.4 ± 4.9 Gy*cm2). Freedom from atrial arrhythmia recurrence was higher for PAF than PsAF patients (OR: 2.0, 95% CI: 1.4–2.9, p = 0.0003), but adjusted mean rates were high in both groups (81.0% vs. 67.9%). Rates were adjusted for prior ablation and age (at 65 years). Conclusion AF ablation using a standardized workflow resulted in low procedure times and variability, with minimal fluoroscopy exposure. Long-term freedom from atrial arrhythmia recurrence was high in both PAF and PsAF populations. Keywords Atrial fibrillation . Catheter ablation . Arrhythmias
1 Introduction Real-time contact force (CF)-sensing catheters have been shown to improve ablation outcomes when compared to non-CF technologies in atrial fibrillation (AF) ablation [1].
* Tom De Potter [email protected] 1
Cardiovascular Center, OLV Hospital, Moorselbaan 169, 9300 Aalst, Belgium
2
CTI Clinical Trial and Consulting Services, Covington, KY, USA
3
Biosense Webster, Inc, Irvine, CA, USA
4
Cardiology Department, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
5
University of Naples Federico II, Naples, Italy
Ablation Index (AI), which integrates CF, power, and ablation time in a logarithmic formula, was shown to be an independent predictor of pulmonary vein (PV) reconnection [2]. Further, a recent study in 100 patients showed that a standardized AI-guided workflow improved 1-year outcomes compared to non-standardized CF ablation [3]. Use of these combined technologies a
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