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Journal of Interventional Cardiac Electrophysiology

Published in:

01-09-2019 | Atrial Fibrillation

The modified ablation index: a novel determinant of acute pulmonary vein reconnections after pulmonary vein isolation

Authors: Yuji Wakamatsu, Koichi Nagashima, Ichiro Watanabe, Ryuta Watanabe, Masaru Arai, Naoto Otsuka, Seina Yagyu, Sayaka Kurokawa, Kimie Ohkubo, Toshiko Nakai, Yasuo Okumura

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2019

Abstract

Background

Although pulmonary vein isolation (PVI) guided by the ablation index (AI) has been well-developed, acute PV reconnections (PVRs) still occur. This study aimed to compare the prognostic performance of the modified AI and its optimal cut-off value for the prediction of acute PVRs to ensure durable PVI.

Methods

Three-dimensional left atrium (LA) voltage maps created before an extensive encircling PVI in 64 patients with atrial fibrillation (AF) (45 men, 62 ± 10 years) were examined for an association between electrogram voltage amplitude recorded from the PV–LA junction and acute post-PVI PVRs (spontaneous PVRs and/or ATP-provoked dormant PV conduction).

Results

Acute PVRs were observed in 22 patients (34%) and 33 (3%) of the 1012 PV segments. Acute PVRs were significantly associated with segments with higher bipolar voltage zones (3.23 ± 1.17 vs. 1.97 ± 1.20 mV, P < 0.0001), lower mean AI values (449 [428–450] vs. 460 [437–486], P = 0.05), and radiofrequency lesion gaps ≥ 6 mm (48 vs. 32%, P = 0.04), but not with contact force, force–time integral, or power. We created the modified AI calculated as AI/LA bipolar voltage, and found it to be significantly lower in areas with acute PVRs than in those without (152 [109–185] vs. 256 [176–413] AU/mV, P < 0.0001). Univariate analysis showed the prognostic performance of the modified AI, with an area under the curve of 0.801 (0.775–0.825), to be the highest of all the significant parameters.

Conclusions

Low values of the novel modified AI on the PV-encircling ablation line were strongly associated with acute PVRs.

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Title: The modified ablation index: a novel determinant of acute pulmonary vein reconnections after pulmonary vein isolation
Authors: Yuji Wakamatsu
Koichi Nagashima
Ichiro Watanabe
Ryuta Watanabe
Masaru Arai
Naoto Otsuka
Seina Yagyu
Sayaka Kurokawa
Kimie Ohkubo
Toshiko Nakai
Yasuo Okumura
Publication date: 01-09-2019
Publisher: Springer US
Keyword: Atrial Fibrillation
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2019
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-018-0501-5

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The modified ablation index: a novel determinant of acute pulmonary vein reconnections after pulmonary vein isolation

Abstract

Background

Methods

Results

Conclusions

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Abstract

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