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A multi‐center experience of ablation index for evaluating lesion delivery in typical atrial flutter
Author(s) -
Maclean Edd,
Simon Ron,
Ang Richard,
Dhillon Gurpreet,
Ahsan Syed,
Khan Fakhar,
Earley Mark,
Lambiase Pier D.,
Rosengarten James,
Chow Anthony W.,
Dhinoja Mehul,
Providencia Rui,
Markides Vias,
Wong Tom,
Hunter Ross J.,
Behar Jonathan M.
Publication year - 2021
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.14228
Subject(s) - medicine , ablation , atrial flutter , sinus rhythm , inferior vena cava , catheter ablation , nuclear medicine , cardiology , atrial fibrillation
Background Anatomical studies demonstrate significant variation in cavotricuspid isthmus (CTI) architecture. Methods Thirty‐eight patients underwent CTI ablation at two tertiary centers. Operators delivered 682 lesions with a target ablation index (AI) of 600 Wgs. Ablation parameters were recorded every 10–20 ms. 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) (R 2 = 0.89, p < .0001). However, analysis by anatomical site demonstrated a non‐linear relationship Mid CTI (R 2 = 0.15, p = .21). Accordingly, while mean AI was highest Mid CTI (IVC: 473.1 ± 122.1 Wgs, Mid: 539.6 ± 103.5 Wgs, V: 486.2 ± 111.8 Wgs, ANOVA p < .0001), mean ID was lower (IVC: 10.7 ± 7.5Ω, Mid: 9.0 ± 6.5Ω, V: 10.9 ± 7.3Ω, p = .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 < .0001). Mean contact force was similar at all sites; however, temporal fluctuations in contact force (IVC: 19.3 ± 12.0 mg/s, Mid: 188.8 ± 92.1 mg/s, V: 102.8 ± 32.3 mg/s, p < .0001) and catheter angle (IVC: 0.42°/s, Mid: 3.4°/s, V: 0.28°/s, p < .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 localized fluctuations in catheter angle and contact force.