Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation
Background: Although Ablation Index (AI)-guided ablation facilitates creation of lesions of consistent depth, pulmonary vein (PV) reconnection is still commonly observed after AI-guided pulmonary vein isolation (PVI). The present study aimed to investigate the impact of local left atrial wall thickn...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906720302724 |
| _version_ | 1818576222605541376 |
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| author | Mark J. Mulder Michiel J.B. Kemme Amaya M.D. Hagen Luuk H.G.A. Hopman Peter M. van de Ven Herbert A. Hauer Giovanni J.M. Tahapary Marco J.W. Götte Albert C. van Rossum Cornelis P. Allaart |
| author_facet | Mark J. Mulder Michiel J.B. Kemme Amaya M.D. Hagen Luuk H.G.A. Hopman Peter M. van de Ven Herbert A. Hauer Giovanni J.M. Tahapary Marco J.W. Götte Albert C. van Rossum Cornelis P. Allaart |
| author_sort | Mark J. Mulder |
| collection | DOAJ |
| description | Background: Although Ablation Index (AI)-guided ablation facilitates creation of lesions of consistent depth, pulmonary vein (PV) reconnection is still commonly observed after AI-guided pulmonary vein isolation (PVI). The present study aimed to investigate the impact of local left atrial wall thickness on the incidence of acute PV reconnection after AI-guided atrial fibrillation (AF) ablation. Methods and results: Seventy patients (63% paroxysmal AF, 67% male, mean age 63 ± 8 years) who underwent preprocedural CT imaging and AI-guided AF ablation were studied. Occurrence of acute PV reconnection after initial PVI was assessed after a 30-minute waiting period. Ablation procedures were retrospectively analyzed and each ablation circle was subdivided into 8 segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were determined for each segment. PV antrum wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units. Acute reconnection occurred in 27/1120 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 19/140 ablation circles (14%). Reconnected segments were characterized by a greater local atrial wall thickness, both in anterior/roof (1.87 ± 0.42 vs. 1.54 ± 0.42 mm; p < 0.01) and posterior/inferior (1.43 ± 0.20 vs. 1.16 ± 0.22 mm; p < 0.01) segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were not associated with acute reconnection. Conclusions: Local atrial wall thickness is associated with acute pulmonary vein reconnection after AI-guided PVI. Individualized AI targets based on local wall thickness may be of use to create transmural ablation lesions and prevent PV reconnection after PVI. |
| first_indexed | 2024-12-16T06:10:35Z |
| format | Article |
| id | doaj.art-e3b374566eba4608b1f1e7acaca94cb5 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-16T06:10:35Z |
| publishDate | 2020-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-e3b374566eba4608b1f1e7acaca94cb52022-12-21T22:41:25ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672020-08-0129100574Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablationMark J. Mulder0Michiel J.B. Kemme1Amaya M.D. Hagen2Luuk H.G.A. Hopman3Peter M. van de Ven4Herbert A. Hauer5Giovanni J.M. Tahapary6Marco J.W. Götte7Albert C. van Rossum8Cornelis P. Allaart9Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the NetherlandsDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the NetherlandsDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the NetherlandsDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the NetherlandsDepartment of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the NetherlandsDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands; Cardiology Centers of the Netherlands, Amsterdam, the NetherlandsDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands; Department of Cardiology, North West Clinics, Alkmaar, the NetherlandsDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the NetherlandsDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the NetherlandsDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands; Corresponding author at: Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.Background: Although Ablation Index (AI)-guided ablation facilitates creation of lesions of consistent depth, pulmonary vein (PV) reconnection is still commonly observed after AI-guided pulmonary vein isolation (PVI). The present study aimed to investigate the impact of local left atrial wall thickness on the incidence of acute PV reconnection after AI-guided atrial fibrillation (AF) ablation. Methods and results: Seventy patients (63% paroxysmal AF, 67% male, mean age 63 ± 8 years) who underwent preprocedural CT imaging and AI-guided AF ablation were studied. Occurrence of acute PV reconnection after initial PVI was assessed after a 30-minute waiting period. Ablation procedures were retrospectively analyzed and each ablation circle was subdivided into 8 segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were determined for each segment. PV antrum wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units. Acute reconnection occurred in 27/1120 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 19/140 ablation circles (14%). Reconnected segments were characterized by a greater local atrial wall thickness, both in anterior/roof (1.87 ± 0.42 vs. 1.54 ± 0.42 mm; p < 0.01) and posterior/inferior (1.43 ± 0.20 vs. 1.16 ± 0.22 mm; p < 0.01) segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were not associated with acute reconnection. Conclusions: Local atrial wall thickness is associated with acute pulmonary vein reconnection after AI-guided PVI. Individualized AI targets based on local wall thickness may be of use to create transmural ablation lesions and prevent PV reconnection after PVI.http://www.sciencedirect.com/science/article/pii/S2352906720302724Acute reconnectionAtrial fibrillationCatheter ablationComputed tomographyPulmonary vein isolationWall thickness |
| spellingShingle | Mark J. Mulder Michiel J.B. Kemme Amaya M.D. Hagen Luuk H.G.A. Hopman Peter M. van de Ven Herbert A. Hauer Giovanni J.M. Tahapary Marco J.W. Götte Albert C. van Rossum Cornelis P. Allaart Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation International Journal of Cardiology: Heart & Vasculature Acute reconnection Atrial fibrillation Catheter ablation Computed tomography Pulmonary vein isolation Wall thickness |
| title | Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation |
| title_full | Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation |
| title_fullStr | Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation |
| title_full_unstemmed | Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation |
| title_short | Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation |
| title_sort | impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after ablation index guided atrial fibrillation ablation |
| topic | Acute reconnection Atrial fibrillation Catheter ablation Computed tomography Pulmonary vein isolation Wall thickness |
| url | http://www.sciencedirect.com/science/article/pii/S2352906720302724 |
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