Author + information
- Received April 28, 2017
- Revision received June 16, 2017
- Accepted June 26, 2017
- Published online January 15, 2018.
- Philippe Taghji, MDa,
- Milad El Haddad, MSc, PhDb,
- Thomas Phlips, MDa,
- Michael Wolf, MDa,
- Sebastien Knecht, MD, PhDa,
- Yves Vandekerckhove, MDa,
- Rene Tavernier, MD, PhDa,
- Hiroshi Nakagawa, MD, PhDc,d and
- Mattias Duytschaever, MD, PhDa,b,∗ ()
- aDepartment of Cardiology, Sint-Jan Hospital Bruges, Bruges, Belgium
- bDepartment of Internal Medicine, Ghent University, Ghent, Belgium
- cHeart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- dDepartment of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- ↵∗Address for correspondence:
Dr. Mattias Duytschaever, Department of Cardiology, Sint-Jan Hospital Bruges; Ruddershove 10, 8000 Bruges, Belgium.
Objectives This study sought to evaluate the safety and the acute and 1 year outcomes of an ablation protocol aiming to enclose the PV with a contiguous and optimized RF circle by targeting region-specific criteria for lesion depth assessed by ablation index and interlesion distance.
Background Reconnections after pulmonary vein (PV) isolation are explained by insufficient lesion depth and/or discontiguity of radiofrequency (RF) lesions.
Methods A total of 130 consecutive patients with paroxysmal atrial fibrillation (AF) underwent PV encircling using a contact force–sensing catheter. RF was delivered targeting interlesion distance ≤6 mm and ablation index ≥400 at posterior wall and ≥550 at anterior wall. Recurrence was defined as any AF, atrial tachycardia (AT), or atrial flutter (AFL) (AF/AT/AFL >30 s) on Holter electrocardiographs at 3, 6, and 12 months.
Results Procedure and RF time per circle were 155 ± 28 min and 17 ± 5 min, respectively. Incidence of first-pass and adenosine-proof isolation were 98% and 98%, respectively. One short-lived transient ischemic attack was observed. At 12 months, single-procedure freedom from AF/AT/AFL was 91.3% in those 104 patients off antiarrhythmic drug therapy and 96.2% in those 26 patients on antiarrhythmic drug therapy. Single-procedure freedom from both AF/AT/AFL and antiarrhythmic drug therapy was 73.1%.
Conclusions This study suggests that an ablation protocol respecting strict criteria for lesion depth and contiguity results in acute durable PV isolation followed by a high single-procedure arrhythmia-free survival at 1 year. A prospective, multicenter trial is ongoing.
Dr. Nakagawa has received consulting fees and a research grant from Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 28, 2017.
- Revision received June 16, 2017.
- Accepted June 26, 2017.
- 2018 American College of Cardiology Foundation
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