Evaluation of a Strategy Aiming to Enclose the Pulmonary Veins With Contiguous and Optimized Radiofrequency Lesions in Paroxysmal Atrial Fibrillation: A Pilot Study
Philippe Taghji, Milad El Haddad, Thomas Phlips, Michael Wolf, Sebastien Knecht, Yves Vandekerckhove, Rene Tavernier, Hiroshi Nakagawa, Mattias Duytschaever, Philippe Taghji, Milad El Haddad, Thomas Phlips, Michael Wolf, Sebastien Knecht, Yves Vandekerckhove, Rene Tavernier, Hiroshi Nakagawa, Mattias Duytschaever
Abstract
Objectives: This study sought to evaluate the safety and the acute and 1 year outcomes of an ablation protocol aiming to enclose the PV with a contiguous and optimized RF circle by targeting region-specific criteria for lesion depth assessed by ablation index and interlesion distance.
Background: Reconnections after pulmonary vein (PV) isolation are explained by insufficient lesion depth and/or discontiguity of radiofrequency (RF) lesions.
Methods: A total of 130 consecutive patients with paroxysmal atrial fibrillation (AF) underwent PV encircling using a contact force-sensing catheter. RF was delivered targeting interlesion distance ≤6 mm and ablation index ≥400 at posterior wall and ≥550 at anterior wall. Recurrence was defined as any AF, atrial tachycardia (AT), or atrial flutter (AFL) (AF/AT/AFL >30 s) on Holter electrocardiographs at 3, 6, and 12 months.
Results: Procedure and RF time per circle were 155 ± 28 min and 17 ± 5 min, respectively. Incidence of first-pass and adenosine-proof isolation were 98% and 98%, respectively. One short-lived transient ischemic attack was observed. At 12 months, single-procedure freedom from AF/AT/AFL was 91.3% in those 104 patients off antiarrhythmic drug therapy and 96.2% in those 26 patients on antiarrhythmic drug therapy. Single-procedure freedom from both AF/AT/AFL and antiarrhythmic drug therapy was 73.1%.
Conclusions: This study suggests that an ablation protocol respecting strict criteria for lesion depth and contiguity results in acute durable PV isolation followed by a high single-procedure arrhythmia-free survival at 1 year. A prospective, multicenter trial is ongoing.
Keywords: CLOSE protocol; atrial fibrillation; contact force; contiguity; lesion depth; pulmonary vein isolation.
Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed