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A multi‐center experience of ablation index for evaluating lesion delivery in typical atrial flutter

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). Green open access

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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
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
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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