PO-622-02 PREDICTOR OF ATRIAL TACHYARRHYTHMIA RECURRENCE AMONG ABLATION STRATEGIES AFTER ABLATION INDEX-GUIDED ATRIAL FIBRILLATION ABLATION

Abstract

Ablation index (AI)-guided atrial fibrillation (AF) ablation improved the procedural success and long-term outcome, but it remained unsatisfactory, especially in non-paroxysmal AF (non-PAF). Various ablation strategies were performed to improve the outcome. However, the strategies vary with the institutions and operators, and predictors of recurrence of atrial tachyarrhythmia (AT) among the strategies remain to be elucidated. We analyzed the predictors of AT recurrence, focusing on high-power radiofrequency application (50W, HP), first-pass pulmonary vein (PV) isolation (FPI), and extra-PV ablation strategies such as left atrium roof linear ablation (LARLA), superior vena cava (SVC) isolation, left atrium posterior wall box isolation (POBI) and complex fractionated atrial electrogram (CFAE) ablation. We retrospectively investigated 1384 patients undergoing the first AI-guided AF ablation from January 2018 to October 2020 (mean age, 67±10 years; female, 422 [31%]; non-PAF, 598 [43%]). HP was performed for 1074 patients (78%) undergoing ablation procedures since November 2018. SVC isolation was performed in all patients with SVC sleeve ≥ 20mm and the other extra-PV ablation strategies at the operator’s discretion. We performed univariate and multivariate analyses by cox proportional hazard model to define the predictors of AT recurrence. During follow-up (mean, 371±160 days), any ATs recurred in 317 patients (24%). Univariate analysis revealed that HP (Hazard ratio [HR], 1.08 [95% confidence interval, 0.83-1.40], p=0.57), FPI in both PV sides (HR, 1.08 [0.87-1.36], p=0.49), and FPI in at least one side (HR, 0.85 [0.61-1.19], p=0.36) had no effect on AT recurrence. Multivariate analysis revealed that LARLA had a negative effect (HR, 1.86 [1.21-2.86], p=0.005) and SVC isolation had a positive effect (HR, 0.71 [0.56-0.89], p=0.003); however, POBI (HR, 1.03 [0.77-1.38], p=0.84) and CFAE ablation (HR, 1.10 [0.78-1.56], p=0.59) had no effect on AT recurrence. The present analysis of a large number of AI-guided AF ablation revealed that HP, FPI, POBI, and CFAE ablation showed no effect, LARLA showed a worsening effect, and SVC isolation showed a protective effect on AT recurrence.