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Evaluation of higher power delivery during RF pulmonary vein isolation using optimized and contiguous lesions
Author(s) -
Kyriakopoulou Maria,
Wielandts JeanYves,
Strisciuglio Teresa,
El Haddad Milad,
Pooter Jan De,
Almorad Alexandre,
Hilfiker Gabriela,
Phlips Thomas,
Unger Philippe,
Lycke Michelle,
Vandekerckhove Yves,
Tavernier Rene,
Duytschaever Mattias,
Knecht Sebastien
Publication year - 2020
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.14438
Subject(s) - medicine , pulmonary vein , ablation , atrial fibrillation , catheter ablation , fluoroscopy , radiofrequency ablation , rf ablation , lesion , catheter , nuclear medicine , cardiology , surgery
Aims “CLOSE”‐guided pulmonary vein isolation (PVI) is based on contiguous (≤6 mm) and optimized radiofrequency (RF) ablation lesions (ablation index [AI] ≥ 400 posteriorly and ≥ 550 anteriorly]. However, the optimal RF power to reach the desired AI is unknown. Therefore we evaluated the efficiency of an ablation strategy using higher power (40 W) during a first “CLOSE”‐guided PVI. Methods Eighty consecutive patients undergoing “CLOSE”‐guided PVI for symptomatic paroxysmal atrial fibrillation were ablated with 40 W (group A). Results were compared with 105 consecutive patients enrolled in the “CLOSE to CURE”‐study and were ablated using the same protocol with 35 W (group B). Results In group A, ablation was associated with shorter ablation procedure time (91 vs 111 minutes; P < .001), shorter fluoroscopy time (5 vs 11 minutes; P < .001), shorter PVI time (48 vs 64 minutes; P < .001), shorter RF time (20 vs 28 minutes; P < .001), lower RF time per application (22 vs 29 seconds; P < .001), less RF applications (52 vs 58; P < .001), and less catheter dislocations (1 vs 2; P = .002). The impedance drop (12 vs 13 Ω; P = .192), first‐pass isolation rate (99% vs 93%; P = .141) and acute reconnection rate (6% vs 4%; P > .733) were similar in both groups (groups A and B, respectively). No complications occurred. In group A, a gastroscopy—performed in five patients with esophageal temperature rise more than 42°C—did not reveal any esophageal lesion. Postprocedural recurrence of atrial tachyarrhythmia at 1 year was not significantly different between both groups. Conclusions Using the “CLOSE”‐protocol, increased power increases the efficiency of PVI without compromising patients' safety.