B-PO04-107 INCIDENCE AND CHARACTERISTICS OF CARINAL ABLATION IN PULMONARY VEIN ISOLATION

Abstract

Radiofrequency ablation (RFA) of the intervenous carinae may be needed for pulmonary vein isolation (PVI) during catheter ablation of atrial fibrillation (AF), possibly due to epicardial connections. We sought to evaluate incidence and characteristics of carinal RFA needed to achieve PVI. A retrospective analysis of 200 AF RFA cases at the Ohio State University Hospital using CARTO 3 (Biosense Webster, Inc.[BSW]), a contact force catheter, real-time lesion quality assessment tool (Ablation Index [AI]) was performed using case data stored on cloud-based storage (CARTONET™, BSW). Each lesion was automatically annotated and regionally assigned to one of the 10 left atrial (LA) anatomical segments (anterior, posterior, inferior, roof, and carina on each side). A total of 22013 lesions were analyzed, including 1302 right and 671 left carinal lesions. PVI was achieved in all 200 patients (50% paroxysmal [PAF] and 50% persistent AF [PersAF]). Carinal RFA was performed only if PVI was not initially achieved after wide area circumferential ablation (WACA) of the PV antra. Ipsilateral only carinal RFA was required in 65 (32.5%) right and 32 (16%) left WACA’s respectively, while 48 (24%) required bilateral carinal RFA and no carinal RFA was required in 55 (27.5%). The right carina required significantly more RFA’s than the left carina (6.5 ± 8.3 vs. 3.4 ± 5.8 [p< 0.001]). There was no difference between the right and left carinae in the contact force (14.2 ± 5.6 g vs 12.5 ± 5.4 g), power (32.2 ± 7.8 W vs. 32.3 ± 7.1 W) or AI (336.8 ±57.4 vs. 327.1 ± 63.1). PersAF required significantly more carinal RFA lesions than PAF (12.3 ± 10.1 vs. 7.45 ± 11.3 [p=0.002]). In 134 patients with carinal RFA and complete AI data, the anterior LA, posterior LA, and the carinae received significantly different levels of AI (429.1 ± 84.8 vs 315.1 ± 48.7 vs. 222.2 ± 79.9 respectively [p< 0.001)]. Carinal RFA was frequently needed for PVI. More RFA in the carinae were needed in right than left PVs consistent with known prevalence of epicardial connections. Interestingly, more carinal RFA was needed in PersAF than PAF. The mean AI in the carinae was significantly lower than AI in anterior and posterior LA. These data may allow more efficient planning of lesion delivery.