Ablation Index guided high-power-short duration radiofrequency (RF-) ablation of the pulmonary veins (PVs) shows high rates of isolation after first encirclement. Nevertheless, in some patients anatomical or procedural difficulties may require touch-up ablation to address any identified conduction gaps. This study was designed to investigate a potential association between an incomplete first encirclement and atrial fibrillation (AF) recurrence rates.
Methods and Results:
First time circumferential pulmonary vein isolation (PVI) was performed in 148 patients using an ablation index guided high-power short duration protocol (irrigated RF energy with targeted power of 50 Watts and an ablation index of 550). All patients were include in a prospective ablation registry study. Baseline characteristics and procedural parameters are show in table 1 and 2. A total of 89.8 % (531/592) of all PVs were isolated after first encirclement. Successful first encirclement of all 4 PVs was achieved in 116/148 (78.4%) patients. Procedural durations were significantly shorter in the first encirclement group (table 2).
Follow up was performed via holter monitoring after 3, 6 and 12 months. Mean follow up was 257 ± 130 days. AF recurrence was defined as AF episodes of >30s in holter recordings or any other symptomatic recurrence.
At the time of the last follow-up 96/116 (82.8%) vs. 20/32 (67.6%) of the included patients had no AF recurrence (p=0.035) (see figure 1).
Conclusion:
This prospective study demonstrates a significant association between failure of first encirclement and AF recurrence. Further studies are needed to identify potential pathophysiological mechanisms.
Figure 1: Recurrence rates at follow up (first pass block vs. no first pass block); p=0.035
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