Author + information
- Received April 28, 2017
- Revision received June 16, 2017
- Accepted June 26, 2017
- Published online September 27, 2017.
- 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 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 and Department 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.
- Received April 28, 2017.
- Revision received June 16, 2017.
- Accepted June 26, 2017.
- 2017 American College of Cardiology Foundation
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