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Journal of Interventional Cardiac Electrophysiology

Published in:

01-04-2021 | Antiarrhythmic Drugs

Rationale and study design for ablation of paroxysmal atrial fibrillation guided by ablation index: a multi-center, prospective randomized trial (PAF-AI trial)

Authors: Ruhong Jiang, Minglong Chen, Jie Fan, Fu Yi, Anli Tang, Xingpeng Liu, Wenqing Zhu, Shaowen Liu, Xiaobo Huang, Weizhu Ju, Xi Zhang, Jie Li, Jiangui He, Liang Shi, Genqing Zhou, Yuegang Wang, Chenyang Jiang

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2021

Abstract

Background

Pulmonary vein isolation (PVI) has become the cornerstone of atrial fibrillation (AF) ablation, but long-term success rates remains suboptimal, due in large part to late PV reconnection and insufficient ostial substrate modification.

Objective

To evaluate whether ablation index (AI)–guided PVI with electrical isolation and quantified ostial substrate modification improves clinical outcomes when compared with contact force (CF)–guided ablation in patients with paroxysmal atrial fibrillation (PAF).

Methods

The PAF-AI trial (ChiCTR1900022041) is a prospective, multi-center, randomized controlled clinical trial enrolling patients with PAF with an indication for catheter ablation. Patients are randomized into a 2:1 fashion to two treatment arms: AI-guided PVI (n = 151) and CF-guided PVI (n = 75). In the AI-guided PVI group, real-time automated display of radiofrequency applications (Visitag™) is used with AI ≥ 500 recommended at the anterior/superior/inferior walls and 350–400 at the posterior wall. In CF-guided PVI group, the value and direction of CF are displayed, with the lesion dots manually annotated. The primary endpoint is the freedom from AF recurrence at 12 months following ablation, without antiarrhythmic drug. The primary pre-specified secondary endpoints include intraprocedural efficiency and peri-procedural complications.

Conclusions

PAF-AI trial compares the effectiveness and safety of two different strategies of PVI in patients with PAF, AI-guided PVI versus more established CF-guided PVI. This prospective, multi-center, randomized controlled trial, with comparative data evaluating procedural and long-term follow-up results, aims to evaluate the impact of AI-guided strategy on AF ablation compared with the current standard of care RF ablation approach.

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Title: Rationale and study design for ablation of paroxysmal atrial fibrillation guided by ablation index: a multi-center, prospective randomized trial (PAF-AI trial)
Authors: Ruhong Jiang
Minglong Chen
Jie Fan
Fu Yi
Anli Tang
Xingpeng Liu
Wenqing Zhu
Shaowen Liu
Xiaobo Huang
Weizhu Ju
Xi Zhang
Jie Li
Jiangui He
Liang Shi
Genqing Zhou
Yuegang Wang
Chenyang Jiang
Publication date: 01-04-2021
Publisher: Springer US
Keywords: Antiarrhythmic Drugs
Atrial Fibrillation
Atrial Flutter
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2021
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-020-00763-5

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Conclusions

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