Maclean, E;
Simon, R;
Ang, R;
Dhillon, G;
Ahsan, SY;
Khan, F;
Earley, M;
... Behar, JM; + view all
(2021)
A multi‐center experience of ablation index for evaluating lesion delivery in typical atrial flutter.
Pacing and Clinical Electrophysiology
10.1111/pace.14228.
(In press).
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Abstract
BACKGROUND: Anatomical studies demonstrate significant variation in cavotricuspid isthmus (CTI) architecture. METHODS: 38 patients underwent CTI ablation at two tertiary centres. Operators delivered 682 lesions with a target ablation index (AI) of 600Wgs. Ablation parameters were recorded every 10-20ms. Post hoc, Visitags were trisected according to CTI position: inferior vena cava (IVC), middle (Mid), or ventricular (V) lesions. RESULTS: There were no complications. 92.1% of patients (n = 35) remained in sinus rhythm after 14.6 ± 3.4 months. For the whole CTI, peak AI correlated with mean impedance drop (ID) (R2 = 0.89, p<0.0001). However, analysis by anatomical site demonstrated a non-linear relationship Mid CTI (R2 = 0.15, p = 0.21). Accordingly, whilst mean AI was highest Mid CTI (IVC: 473.1 ± 122.1Wgs, Mid: 539.6 ± 103.5Wgs, V: 486.2 ± 111.8Wgs, ANOVA p<0.0001), mean ID was lower (IVC: 10.7 ± 7.5Ω, Mid: 9.0 ± 6.5Ω, V: 10.9 ± 7.3Ω, p = 0.011), and rate of ID was slower (IVC: 0.37 ± 0.05 Ω/s, Mid: 0.18 ± 0.08 Ω/s, V: 0.29 ± 0.06 Ω/s, p<0.0001). Mean contact force was similar at all sites, however temporal fluctuations in contact force (IVC: 19.3 ± 12.0mg/s, Mid: 188.8 ± 92.1mg/s, V: 102.8 ± 32.3mg/s, p<0.0001) and catheter angle (IVC: 0.42°/s, Mid: 3.4°/s, V: 0.28°/s, p<0.0001) were greatest Mid CTI. Use of a long sheath attenuated these fluctuations and improved energy delivery. CONCLUSIONS: Ablation characteristics vary across the CTI. At the Mid CTI, higher AI values do not necessarily deliver more effective ablation; this may reflect localised fluctuations in catheter angle and contact force. This article is protected by copyright. All rights reserved.
| Type: | Article |
|---|---|
| Title: | A multi‐center experience of ablation index for evaluating lesion delivery in typical atrial flutter |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/pace.14228 |
| Publisher version: | https://doi.org/10.1111/pace.14228 |
| Language: | English |
| Additional information: | Copyright © 2021 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
| Keywords: | ablation index, atrial flutter, catheter ablation, cavo-tricuspid isthmus, force sensing |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10127246 |
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