Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation.

Falasconi, G ; Penela, D ; Soto-Iglesias, D ; Francia, P ; Teres, C ; Saglietto, A ; Jauregui, B (Universidad de Zaragoza) ; Viveros, D ; Bellido, A ; Alderete, J ; Meca-Santamaria, J ; Franco, P ; Gaspardone, C ; San Antonio, R ; Huguet, M ; Cámara, Ó ; Ortiz-Pérez, JT ; Martí-Almor, J ; Berruezo, A

Resumen: Aims
Pulmonary vein (PV) antrum isolation proved to be effective for treating persistent atrial fibrillation (PeAF). We sought to investigate the results of a personalized approach aimed at adapting the ablation index (AI) to the local left atrial wall thickness (LAWT) in a cohort of consecutive patients with PeAF.

Methods and results
Consecutive patients referred for PeAF first ablation were prospectively enrolled. The LAWT three-dimensional maps were obtained from pre-procedure multidetector computed tomography and integrated into the navigation system. Ablation index was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the PV antrum. A total of 121 patients (69.4% male, age 64.5 ± 9.5 years) were included. Procedure time was 57 min (IQR 50–67), fluoroscopy time was 43 s (IQR 20–71), and radiofrequency (RF) time was 16.5 min (IQR 14.3–18.4). The median AI tailored to the local LAWT was 387 (IQR 360–410) for the anterior wall and 335 (IQR 300–375) for the posterior wall. First-pass PV antrum isolation was obtained in 103 (85%) of the right PVs and 103 (85%) of the left PVs. Median LAWT values were higher for PVs without first-pass isolation as compared to the whole cohort (P = 0.02 for left PVs and P = 0.03 for right PVs). Recurrence-free survival was 79% at 12 month follow-up.

Conclusion
In this prospective study, LAWT-guided PV antrum isolation for PeAF was effective and efficient, requiring low procedure, fluoroscopy, and RF time. A randomized trial comparing the LAWT-guided ablation with the standard of practice is in progress (ClinicalTrials.gov, NCT05396534).

Idioma: Inglés

DOI: 10.1093/europace/euad118

Año: 2023

Publicado en: Europace 25 (2023), [15 pp.]
ISSN: 1099-5129

Factor impacto JCR: 7.9 (2023)

Categ. JCR: CARDIAC & CARDIOVASCULAR SYSTEMS rank: 19 / 222 = 0.086 (2023) - Q1 - T1

Factor impacto CITESCORE: 10.3 - Cardiology and Cardiovascular Medicine (Q1) - Physiology (medical) (Q1)

Factor impacto SCIMAGO: 2.895 - Physiology (medical) (Q1) - Cardiology and Cardiovascular Medicine (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)