Ding, Wern Yew 
ORCID: 0000-0003-3596-6545, Tovmassian, Lilith, Bierme, Cedric, Kozhuharov, Nikola, Snowdon, Richard L and Gupta, Dhiraj
(2022)
Ablation index-guided 50W radiofrequency ablation for left atrial posterior wall isolation in atrial fibrillation.
Indian pacing and electrophysiology journal, 22 (4).
pp. 200-206.
Abstract
<h4>Background</h4>Ablation index (AI)-guided ablation for posterior wall isolation (PWI) using high-power, short-duration remains untested. We sought to evaluate the acute outcomes of AI-guided 50 W ablation vs. conventional ablation, and investigate the differences in relationship between contact force (CF), time and AI in both groups.<h4>Methods</h4>Consecutive patients undergoing first-time AI-guided ablation with PWI using either 50 W or 35-40 W ablation were enrolled. Acute procedural metrics and individual lesion level ablation data were compared between groups.<h4>Results</h4>40 patients (50 W: n = 20, 35-40 W: n = 20) with atrial fibrillation were included. Total procedure time was significantly reduced with 50 W (120 vs. 143 mins, p = 0.004) and there was a trend toward decreased ablation time (22 vs. 28 mins, p = 0.052). First pass and acute success of PWI were comparable between the 50 W and 35-40 W groups (10 vs. 8 patients, p = 0.525 and 20 vs. 19 patients, p = 1.000, respectively). Individual lesion analysis of all 959 RF applications (50 W: n = 458, 35-40 W: n = 501) demonstrated that 50 W ablation led to lower ablation time per lesion (10.4 vs. 13.0s, p < 0.001), and increased AI (471 vs. 461, p < 0.001) and impedance drop (7.4 vs. 6.9ohms, p = 0.007). Excessive ablations (AI>600 for roof line; AI>500 elsewhere) were more frequently observed in the 50 W group (9.0% vs. 4.6%, p = 0.007). CF had very good discriminative capability for excessive ablation in both groups. At 50 W, limiting the CF to <10 g reduced the number of excessive ablations on the floor line and within the posterior box to 12% and 4%,respectively. Recurrence of atrial arrhythmias at 12 months were comparable between the groups.<h4>Conclusion</h4>AI-guided 50 W RF ablation reduces the ablation time of individual lesions and total procedure time without compromising first pass and acute success rates of PWI or 12-month outcomes compared to conventional powers.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | 50W, Ablation, Atrial fibrillation, Box, High-power, Isolation, Posterior wall, Short-duration |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 18 Jan 2023 10:20 |
| Last Modified: | 18 Jan 2023 10:20 |
| DOI: | 10.1016/j.ipej.2022.05.002 |
| Open Access URL: | https://doi.org/10.1016/j.ipej.2022.05.002 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3167111 |
Dimensions
Dimensions
