Comparison of myocardial injury and inflammation between ablation index-guided and conventional contact force-guided ablation in atrial fibrillation patients

Abstract

Abstract Background Ablation index (AI)-guided ablation improves the incidence of arrhythmia recurrence as compared to conventional contact force (CF)-guided ablation. Purpose The aim of this study was to elucidate the differences in the biomarkers associated with myocardial injury and inflammation between conventional CF-guided and AI-guided ablation. Methods Atrial fibrillation (AF) patients who underwent pulmonary vein isolation (PVI) from the Osaka Rosai Atrial Fibrillation ablation (ORAF) registry were enrolled. We divided the patients into two groups: conventional CF-guided PVI (CF group) and AI-guided PVI (AI group). The differences in biomarkers associated with myocardial injury and inflammation, and long-term durability of PVI between the two groups were evaluated. Results This study population included a total of 794 patients (CF-guided, 241 patients; AI-guided, 553 patients). Total application time was significantly shorter, and total application number was significantly smaller in AI than CF group. High-sensitive troponin I (hs-TnI) post-ablation was significantly higher in AI than CF group (p<0.001), even after taking the total application number and total application time into consideration. No significant differences in inflammatory markers changes from pre- to post-ablation were observed between the two groups. Multiple regression analysis showed that age, AF type, AI-guided ablation and creatinine were significantly associated with the acute myocardial injury (hs-TnI value) after catheter ablation (standardized beta-coefficient=-0.096, p=0.013, standardized beta-coefficient=0.159, p<0.001, standardized beta-coefficient=0.078, p=0.031 and standardized beta-coefficient=0.118, p=0.003, respectively). AI-guided ablation was significantly associated with the hs-TnI post-ablation by multiple regression analysis. The PV reconnection ratio was significantly smaller in AI than CF group (p=0.037). Conclusion According to the results of the biomarkers during AF ablation, AI-guided ablation had the ability to create larger lesions than CF-guided ablation, but had an equivalent inflammatory status to CF-guided ablation. The differences in myocardial injury and inflammation could be the mechanism of the better durability of PVI for AI-guided ablation.