Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Learning curve after establishing a high power short duration , ablation index guided protocol for atrial fibrillation ablation
F. Schwarz1, P. Kamieniarz1, V. Tscholl1, P. Nagel1, K. Stangl2, U. Landmesser1, M. Huemer1, P. Attanasio1
1CC 11: Med. Klinik für Kardiologie, Charité - Universitätsmedizin Berlin, Berlin; 2CC11: Med. Klinik m. S. Kardiologie und Angiologie, Charité - Universitätsmedizin Berlin, Berlin;

Introduction:

Pulmonary vein isolation (PVI) using a high power short duration and ablation index guided protocol has led to very short procedural times. This is caused in part by shorter ablation times per lesion, but also by high rates of PVI after first encirclement. This analysis was performed to analyze a potential learning curve using this workflow and its influence on rates of fist pass encirclement

Methods and results:

The first 100 procedures performed by two experienced operators using the high power short duration and ablation index guided protocol for PVI were analyzed. Procedural times and rates of first pass encirclement between the first and second half of the procedures were compared.

Baseline characteristics and procedural parameters are show in table 1 and 2. Of a total of 400 PVs, 150/200 (75 %) vs. 192/200 (96%) (p>0.001) were isolated after first encirclement in the first 50 vs. the last 50 procedures. First pass block of all 4 PVs was  31/50 (62%) vs. 46/50 (92%) (p=0.004). Procedural time and left atrial dwell times were 92 ± 21 vs. 78 ± 34 minutes (p=0.001) and 72 ± 18 vs. 60 ± 22 minutes (p=0.004).

Conclusion:

This small prospective study demonstrates a steep learning curve leading to very high first pass block rates and shorter procedure times after the first 50 procedures performed.

Table 1: Characteristics of the study population (n 100) First 50 patients (n 50) Second 50 patients (n 50) p-value
Age (y) 68.2±11.2 67.2±69.1 p=0.34
Female gender 20 (40) 18 (36) p=0.68
BMI (kg/m2) 26.9±5.3 29.1±4.4 p=0.03
LVEF (%) 58.1±10.4 58.4±12 p=0.89
Left atrial volume (ml) 68.6±25 75.9±26 p=0.24
Paroxysmal AF 29 (58) 29 (58) p=0.11
Persistent AF 21 (42) 21 (42) p=0.11
Coronary artery disease 14 (28) 16 (32) p=0.66
Diabetes 10 (20) 6 (12) p=0.275
Hypertension 44 (88) 37 (74) p=0.07
Values are given as mean ±SD or n (%), BMI: Body Mass Index; PVI: pulmonary vein isolation; AF: atrial fibrillation; TIA: transient ischemic attack; LVEF: left ventricular ejection fraction    

Table 2: Procedural Parameters Isolation at first encirclement (n 116) No Isolation at first encirclement (n 32) p-value
Total procedure time (min ±SD) 92 ± 21 78 ±34 p=0.001
Left atrial time (min ±SD) 72 ± 18 60±22 p=0.04
Ablation time (min ±SD) 19:21 ± 6:54 17:38±03:44 p=0.15
       
https://dgk.org/kongress_programme/jt2022/aP1178.html