Analysis of late reconnections after pulmonary vein isolation: Impact of interlesion contiguity and ablation index.

Abstract

Interlesion distance and ablation index (AI) have been proposed as parameters of radiofrequency (RF) lesion durability. This study analyzes the relationship between RF parameters of automatically acquired lesion tags and late reconnections in repeat pulmonary vein isolation (PVI) procedures. One hundred fifty-seven patients underwent contact force (CF)-guided PVI with automatic acquisition of RF lesions. During follow-up, 21 patients underwent a repeat PVI procedure. The relationship between RF parameters (power, CF, impedance drop, and AI) of the initial PVI procedure and reconnections observed at repeat PVI was analyzed. Visual gap was defined as the existence of a discontinuity between two RF lesions automatically acquired in the initial PVI procedure. Regional values of AI associated with lesion durability were identified. Twenty-one patients were included. Three hundred thirty-six segments and 2507 RF lesions were analyzed. The median interval between the initial and repeat PVI procedures was 17 (11-24) months. All patients showed≥1 reconnected segment. Sixty-three segments (18.7%) were reconnected. Reconnected segments showed visual gaps more frequently than non-reconnected segments (66.6%vs 17.6%; P<.001; negative predictive value 91.4%). The mean distance of visual gaps was 8±2.8mm. No differences were observed in power (31.4±4.7W vs 31±4.1W; P=.573), CF (14.4±5.3g vs 15.4±5.4g; P=.315), and impedance drop (6.9±5.2 ohms vs 6.5±3.8 ohms; P=.576) between reconnected and non-reconnected segments. Among segments without visual gap, the minimum AI value was significantly higher in the non-reconnected segments (325±96.1 vs 204.7±78.5; P<.001). No reconnections were observed in segments without visual gap and minimum AI≥330/220 in anterior/posterior wall, respectively. Contiguity between automatically acquired RF lesions and minimum AI value are the main determinants of long-term PVI durability.