Ablation index–guided pulmonary vein isolation can reduce early recurrences of atrial tachyarrhythmias: a propensity score–matched analysis,Journal of Interventional Cardiac Electrophysiology

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Ablation index–guided pulmonary vein isolation can reduce early recurrences of atrial tachyarrhythmias: a propensity score–matched analysis
Journal of Interventional Cardiac Electrophysiology ( IF 2.1 ) Pub Date : 2021-10-21 , DOI: 10.1007/s10840-021-01059-y
Koji Yasumoto ₁ , Yasuyuki Egami ₁ , Kohei Ukita ₁ , Akito Kawamura ₁ , Hitoshi Nakamura ₁ , Yutaka Matsuhiro ₁ , Masaki Tsuda ₁ , Naotaka Okamoto ₁ , Akihiro Tanaka ₁ , Yasuharu Matsunaga-Lee ₁ , Masamichi Yano ₁ , Ryu Shutta ₁ , Yasushi Sakata ₂ , Masami Nishino ₁ , Jun Tanouchi ₁

Affiliation

Purpose

Early recurrence of atrial tachyarrhythmias (ERAT) cause various symptoms and predict worse outcomes after pulmonary vein isolation (PVI). This study aimed to clarify whether ablation index (AI)–guided PVI, which is a novel technology of radiofrequency ablation, could reduce ERAT as compared to conventional contact force (CF)–guided PVI.

Methods

Consecutive atrial fibrillation (AF) patients who underwent initial PVI from September 2014 to August 2019 were enrolled. We divided the patients into two groups: patients who underwent AI-guided PVI (AI group) and those who underwent CF-guided PVI (CF group). Using propensity score matching (PSM), we adjusted for the patient backgrounds. We compared the incidence of ERAT and late reconnection rate of isolated pulmonary veins (PVs) during second session between the two groups. ERAT was defined as any atrial tachyarrhythmias ≥ 30 s during a 90-day blanking period.

Results

A total of 697 AF patients (paroxysmal 51%) were enrolled. After the PSM, both groups included 229 patients. The incidence of ERAT was significantly lower in the AI group than that in the CF group (21.5% vs. 36.1%, P < 0.001). Total 118 patients (25.7%) experienced late recurrence of atrial tachyarrhythmias (LRAT) after blanking period. LRAT free survival rate was significantly higher in patients without ERAT than those with ERAT (88.1% vs. 42.0%, P < 0.001). The rate of PV reconnection was lower in the AI group than that in the CF group (45.8% vs. 71.4%, P = 0.028). Multivariate analysis demonstrated that AI-guided PVI was independently correlated with ERAT (OR = 0.415, 95%CI = 0.269–0.639, P < 0.001).

Conclusions

AI-guided PVI can reduce ERAT as compared to conventional CF-guided PVI.

中文翻译：

消融指数引导的肺静脉隔离可减少房性快速性心律失常的早期复发：倾向评分匹配分析

目的

房性快速性心律失常 (ERAT) 的早期复发会导致各种症状，并预测肺静脉隔离 (PVI) 后更糟糕的结果。本研究旨在阐明与传统接触力 (CF) 引导的 PVI 相比，消融指数 (AI) 引导的 PVI（一种射频消融新技术）是否可以降低 ERAT。

方法

入组 2014 年 9 月至 2019 年 8 月接受初始 PVI 的连续房颤（AF）患者。我们将患者分为两组：接受 AI 引导的 PVI 的患者（AI 组）和接受 CF 引导的 PVI 的患者（CF 组）。使用倾向评分匹配 (PSM)，我们针对患者背景进行了调整。我们比较了两组在第二次治疗期间 ERAT 的发生率和孤立肺静脉 (PV) 的晚期重新连接率。ERAT 定义为在 90 天的空白期内任何房性快速性心律失常≥ 30 秒。

结果

共招募了 697 名 AF 患者（阵发性 51%）。在 PSM 之后，两组均包括 229 名患者。AI组ERAT的发生率明显低于CF组（21.5% vs. 36.1%，P < 0.001）。共有 118 名患者 (25.7%) 在消隐期后经历了房性快速性心律失常 (LRAT) 的晚期复发。无 ERAT 患者的无 LRAT 生存率显着高于有 ERAT 患者（88.1% vs. 42.0%，P < 0.001）。AI 组 PV 再连接率低于 CF 组（45.8% vs. 71.4%，P = 0.028）。多变量分析表明，AI 引导的 PVI 与 ERAT 独立相关（OR = 0.415, 95%CI = 0.269–0.639, P < 0.001）。