Ablation Index Guided Left Atrial Posterior Wall Isolation

Abstract

Ablation index (AI)-guided linear ablation is reported to be feasible.We assessed the feasibility of AI-guided left atrial (LA) posterior wall isolations (PWIs) using different target AI values.Seventy-one persistent atrial fibrillation patients who underwent AI-guided PWIs following pulmonary vein isolation were included. LA linear lesions were created with strict contiguity (inter-lesion distance < 4 mm) and different predetermined AI target values (Group-1: 430, Group-2: 450). The data was analyzed retrospectively.The total radiofrequency application time of the roof and bottom-line ablation was a median of 2.8 (2.0, 3.8) and 3.6 (2.8, 4.3) minutes. The first-pass PWI success rate (26/35 [74.3%] versus 16/36 [44.4%], P = 0.011) and a first-pass roof line block (28/35 [80.0%] versus 21/36 [58.3%], P = 0.048) were significantly higher in Group-2 than Group-1, but that for the first-pass bottom line block was similar between Group-1 and Group-2 (29/36 [80.6%] versus 29/35 [82.9%], P = 0.80). Successful PWIs were achieved by additional applications in all. The significant parameter associated with a successful first-pass LA roof line block was a greater RF power, and that for the LA bottom were a higher radiofrequency power and shorter inter-lesion distance. Conduction gaps were mostly located at the middle of both lines. Among 22 roof line gaps, 12 were closed on the line whereas 10 (45.4%) required ablation inside the posterior wall for PWIs. On the contrary, all 11 gaps on bottom lines were closed on the line.Successful first-pass PWIs were obtained in 74% of patients using a target AI value of 450 and strict criteria for the lesion contiguity.