Author + information
- Pouria Alipour,
- Yaariv Khaykin,
- Zahra Azizi,
- Meysam Pirbaglou,
- Sergio Conti,
- Paul Ritvo,
- Alfredo Pantano and
- Atul Verma
Background: PVAI is one of the most effective therapies in patients refractory to medical treatment of atrial fibrillation (AF), however it still remains a technically difficult procedure with a poor long term success rate. Using objective lesion demarcation software to improve the consistency of lesion delivery based on catheter stability and RF time has been shown to improve long term AF-free survival. Recent technological advances allow the operator to integrate contact force as one of the lesion demarcation parameters. This study aims to evaluate the ideal amount of force, and force time integral (FTI) required to minimize AF recurrences following ablation.
Methods: Amount of Force (g), and values for FTI (gs) from 155 ablation points in 3 patients (66% Male, Mean Age: 68.3±5.3 Years) who underwent redo ablation were collected. Baseline and redo ablations were carried out using catheters and software which allowed documentation of contact force and catheter stability. All lesion points were obtained in a blind fashion from ablation points demarcated by the CARTO3 VisiTag™ algorithm. Using an ROC curve the Force and FTI values that yielded the lowest likelihood of the area having to be reablated at the time of the second procedure were determined.
Results: Average force and FTI during the first ablation in areas with reconnection requiring repeat ablation at the time of the redo procedure was lower than that in areas without reconnection (F: 10.1±6.11g, FTI: 151±114 g.s, vs. 15.8±11.7g and 245±204 g·sec, P=0.006 and P=0.021 respectively). Additionally, ROC analysis revealed an area under the curve of 0.846 (CI: 0.772-0.920, P<0.0001) and 0.849 (CI:0.775-0.923, P<0.0001) for force and FTI respectively. Furthermore, same analysis revealed force of 10.5g (89.2% sensitivity, and 84% specificity, P<0.0001) (Figure1A), and FTI of 154.50 g·sec (89.2% sensitivity, and 82.7% specificity, P<0.0001)(Figure1B) to be the ideal amount of force applied.
Conclusions: Application of 11 grams or 155 grams seconds of force per lesion during PVAI would reduce or eliminate the risk of local reconnection, and ultimately lower the risk of AF recurrence and repeat ablation. This finding warrants prospective validation.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: AF Ablation
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1150-094
- 2017 American College of Cardiology Foundation