Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients

Ahmed Hussein, Moloy Das, Stefania Riva, Maureen Morgan, Christina Ronayne, Ankita Sahni, Matthew Shaw, Derick Todd, Mark Hall, Simon Modi, Andrea Natale, Antonio Dello Russo, Richard Snowdon, Dhiraj Gupta

Research output: Contribution to journalArticle

Abstract

Background Catheter ablation for persistent atrial fibrillation (AF) is associated with less favorable outcomes than for paroxysmal AF. Substrate modification is often added to pulmonary vein isolation (PVI) to try to improve success rates. Recent studies have shown improved clinical outcomes with use of regional ablation index (AI) targets for PVI. We hypothesized that prospective use of AI-guided PVI in persistent AF patients would result in a low rate of PV reconnection at repeat electrophysiology study and that a high success rate can be achieved with durable PVI alone. Methods Forty consecutive patients with persistent AF underwent AI-guided PVI with target values of 550 for anterior and 400 for posterior left atrial regions, followed by a protocol-mandated repeat procedure after 2 months. Patients were monitored for atrial tachyarrhythmia recurrence via daily plus symptom-initiated ECG recordings for 12 months. Recurrence was defined as ≥30 seconds of any atrial tachyarrhythmia after a 3-month blanking period. Results PV reconnection was seen at repeat electrophysiology study in 22% of patients, affecting 7% of PVs. Ablation on the intervenous carina was required in 44% patients to achieve durable PVI. Atrial tachyarrhythmia recurrence was documented in 8 (20%) patients, only one of whom had PV reconnection at repeat study. At 12 months, 38/40 (95%) patients were in sinus rhythm, with 4 (10%) patients having started antiarrhythmic drugs. Higher body mass index and excess alcohol consumption were the only significant factors associated with atrial tachyarrhythmia recurrence. Conclusions Use of AI targets results in a high level of durable PVI. A good clinical outcome can be achieved in the great majority of persistent AF patients with AI-guided PVI alone. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02628730.

Original languageEnglish
Pages (from-to)e006576
JournalCirculation: Arrhythmia and Electrophysiology
Volume11
Issue number9
DOIs
Publication statusPublished - Sep 2018

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Pulmonary Veins
Atrial Fibrillation
Cardiac Arrhythmias
Tachycardia
Recurrence
Electrophysiology
Catheter Ablation
Anti-Arrhythmia Agents
Alcohol Drinking
Electrocardiography
Body Mass Index
Clinical Trials

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Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients. / Hussein, Ahmed; Das, Moloy; Riva, Stefania; Morgan, Maureen; Ronayne, Christina; Sahni, Ankita; Shaw, Matthew; Todd, Derick; Hall, Mark; Modi, Simon; Natale, Andrea; Dello Russo, Antonio; Snowdon, Richard; Gupta, Dhiraj.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 11, No. 9, 09.2018, p. e006576.

Research output: Contribution to journalArticle

Hussein, Ahmed ; Das, Moloy ; Riva, Stefania ; Morgan, Maureen ; Ronayne, Christina ; Sahni, Ankita ; Shaw, Matthew ; Todd, Derick ; Hall, Mark ; Modi, Simon ; Natale, Andrea ; Dello Russo, Antonio ; Snowdon, Richard ; Gupta, Dhiraj. / Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients. In: Circulation: Arrhythmia and Electrophysiology. 2018 ; Vol. 11, No. 9. pp. e006576.
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abstract = "Background Catheter ablation for persistent atrial fibrillation (AF) is associated with less favorable outcomes than for paroxysmal AF. Substrate modification is often added to pulmonary vein isolation (PVI) to try to improve success rates. Recent studies have shown improved clinical outcomes with use of regional ablation index (AI) targets for PVI. We hypothesized that prospective use of AI-guided PVI in persistent AF patients would result in a low rate of PV reconnection at repeat electrophysiology study and that a high success rate can be achieved with durable PVI alone. Methods Forty consecutive patients with persistent AF underwent AI-guided PVI with target values of 550 for anterior and 400 for posterior left atrial regions, followed by a protocol-mandated repeat procedure after 2 months. Patients were monitored for atrial tachyarrhythmia recurrence via daily plus symptom-initiated ECG recordings for 12 months. Recurrence was defined as ≥30 seconds of any atrial tachyarrhythmia after a 3-month blanking period. Results PV reconnection was seen at repeat electrophysiology study in 22{\%} of patients, affecting 7{\%} of PVs. Ablation on the intervenous carina was required in 44{\%} patients to achieve durable PVI. Atrial tachyarrhythmia recurrence was documented in 8 (20{\%}) patients, only one of whom had PV reconnection at repeat study. At 12 months, 38/40 (95{\%}) patients were in sinus rhythm, with 4 (10{\%}) patients having started antiarrhythmic drugs. Higher body mass index and excess alcohol consumption were the only significant factors associated with atrial tachyarrhythmia recurrence. Conclusions Use of AI targets results in a high level of durable PVI. A good clinical outcome can be achieved in the great majority of persistent AF patients with AI-guided PVI alone. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02628730.",
author = "Ahmed Hussein and Moloy Das and Stefania Riva and Maureen Morgan and Christina Ronayne and Ankita Sahni and Matthew Shaw and Derick Todd and Mark Hall and Simon Modi and Andrea Natale and {Dello Russo}, Antonio and Richard Snowdon and Dhiraj Gupta",
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TY - JOUR

T1 - Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients

AU - Hussein, Ahmed

AU - Das, Moloy

AU - Riva, Stefania

AU - Morgan, Maureen

AU - Ronayne, Christina

AU - Sahni, Ankita

AU - Shaw, Matthew

AU - Todd, Derick

AU - Hall, Mark

AU - Modi, Simon

AU - Natale, Andrea

AU - Dello Russo, Antonio

AU - Snowdon, Richard

AU - Gupta, Dhiraj

PY - 2018/9

Y1 - 2018/9

N2 - Background Catheter ablation for persistent atrial fibrillation (AF) is associated with less favorable outcomes than for paroxysmal AF. Substrate modification is often added to pulmonary vein isolation (PVI) to try to improve success rates. Recent studies have shown improved clinical outcomes with use of regional ablation index (AI) targets for PVI. We hypothesized that prospective use of AI-guided PVI in persistent AF patients would result in a low rate of PV reconnection at repeat electrophysiology study and that a high success rate can be achieved with durable PVI alone. Methods Forty consecutive patients with persistent AF underwent AI-guided PVI with target values of 550 for anterior and 400 for posterior left atrial regions, followed by a protocol-mandated repeat procedure after 2 months. Patients were monitored for atrial tachyarrhythmia recurrence via daily plus symptom-initiated ECG recordings for 12 months. Recurrence was defined as ≥30 seconds of any atrial tachyarrhythmia after a 3-month blanking period. Results PV reconnection was seen at repeat electrophysiology study in 22% of patients, affecting 7% of PVs. Ablation on the intervenous carina was required in 44% patients to achieve durable PVI. Atrial tachyarrhythmia recurrence was documented in 8 (20%) patients, only one of whom had PV reconnection at repeat study. At 12 months, 38/40 (95%) patients were in sinus rhythm, with 4 (10%) patients having started antiarrhythmic drugs. Higher body mass index and excess alcohol consumption were the only significant factors associated with atrial tachyarrhythmia recurrence. Conclusions Use of AI targets results in a high level of durable PVI. A good clinical outcome can be achieved in the great majority of persistent AF patients with AI-guided PVI alone. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02628730.

AB - Background Catheter ablation for persistent atrial fibrillation (AF) is associated with less favorable outcomes than for paroxysmal AF. Substrate modification is often added to pulmonary vein isolation (PVI) to try to improve success rates. Recent studies have shown improved clinical outcomes with use of regional ablation index (AI) targets for PVI. We hypothesized that prospective use of AI-guided PVI in persistent AF patients would result in a low rate of PV reconnection at repeat electrophysiology study and that a high success rate can be achieved with durable PVI alone. Methods Forty consecutive patients with persistent AF underwent AI-guided PVI with target values of 550 for anterior and 400 for posterior left atrial regions, followed by a protocol-mandated repeat procedure after 2 months. Patients were monitored for atrial tachyarrhythmia recurrence via daily plus symptom-initiated ECG recordings for 12 months. Recurrence was defined as ≥30 seconds of any atrial tachyarrhythmia after a 3-month blanking period. Results PV reconnection was seen at repeat electrophysiology study in 22% of patients, affecting 7% of PVs. Ablation on the intervenous carina was required in 44% patients to achieve durable PVI. Atrial tachyarrhythmia recurrence was documented in 8 (20%) patients, only one of whom had PV reconnection at repeat study. At 12 months, 38/40 (95%) patients were in sinus rhythm, with 4 (10%) patients having started antiarrhythmic drugs. Higher body mass index and excess alcohol consumption were the only significant factors associated with atrial tachyarrhythmia recurrence. Conclusions Use of AI targets results in a high level of durable PVI. A good clinical outcome can be achieved in the great majority of persistent AF patients with AI-guided PVI alone. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT02628730.

U2 - 10.1161/CIRCEP.118.006576

DO - 10.1161/CIRCEP.118.006576

M3 - Article

C2 - 30354288

VL - 11

SP - e006576

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

SN - 1941-3149

IS - 9

ER -