Abstract

Objectives

We aimed to investigate the predictors of recurrent arrhythmia after repeated pulmonary vein isolation (PVI) performed in the era of contact force without additional substrate ablation. One of the predictors studied, ablation index (AI), incorporates power, contact force, and time in a weighted formula and is reported to predict lesion size in animals. Design. Consecutive patients (n = 108) undergoing repeat PVI without additional substrate modification using a contact force sensing catheter were included retrospectively at a tertiary center. All ablation points were analyzed offline. A new variable, normalized AI (AI corrected for the location of the lesion—anterior vs. posterior) was calculated. The patients were systematically followed with clinical visit and 12-lead ECG as well as review of the regional electronic patient files at 3 and 12 months after the procedure with 5-day Holter at 12 months. Results. Electrical reconnection to at least one pulmonary vein (PV) was seen in 97% of the patients. The recurrence rate was 35%. There was no recurrence in patients with nAI above 1.15 (n = 26). Patients with electrical reconnection of up to two PVs had a higher risk of recurrence compared with patients having electrical reconnection of three or four PVs (p = .003), and this risk was especially high in patients with persistent atrial fibrillation (69 [39–91]%). Conclusions. The risk of recurrence is higher in patients with ablations performed with low levels of AI and in patients with reconnection to up to two PVs. Our data may indicate the need for higher target levels of AI during repeat PVI than normally used during de-novo PVI.

中文翻译：

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房颤患者重复肺静脉隔离：低消融指数与复发性心律失常风险增加有关

摘要

目标

我们旨在研究在接触力时代进行的重复肺静脉隔离 (PVI) 后复发性心律失常的预测因素，而无需额外的基底消融。研究的预测因子之一，消融指数 (AI)，在加权公式中结合了功率、接触力和时间，据报道可预测动物的病变大小。设计。连续患者 ( n = 108) 在三级中心回顾性地包括使用接触力传感导管进行重复 PVI 而不进行额外的基底修改。离线分析所有消融点。计算了一个新的变量，归一化的 AI（AI 校正了病变的位置 - 前部与后部）。在手术后 3 个月和 12 个月，对患者进行系统随访，包括临床访视和 12 导联心电图，以及在 12 个月时使用 5 天动态心电图查看区域电子患者档案。结果。在 97% 的患者中观察到与至少一个肺静脉 (PV) 的电重新连接。复发率为35%。nAI 高于 1.15 的患者无复发（n = 26）。与具有三个或四个 PV 的电重新连接的患者相比，具有多达两个 PV 的电重新连接的患者具有更高的复发风险（p  = .003），并且这种风险在持续性心房颤动的患者中尤其高（69 [39– 91]%）。结论。在低水平 AI 下进行消融的患者和重新连接至多达两个 PV 的患者中，复发风险更高。我们的数据可能表明在重复 PVI 期间需要比在从头PVI期间通常使用更高的 AI 目标水平。