Is There an Upper Limit of Ablation Index? The Fair Compromise between Safety and Efficacy
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 11, Issue 5
Abstract
Perforation during catheter procedures is relatively uncommon, but potentially fatal if tamponade ensues. This case analyzes the relationship between the occurrence of cardiac perforation during AF Radio Frequency ablation and the Ablation Index (AI), a single index value representing force, contact, time during Pulmonary Vein Isolation (PVI) point-by-point encircling.Pulmonary Vein Isolation (PVI) is the cornerstone of ablation for paroxysmal and persistent Atrial Fibrillation (AF). Durability of PVs isolation remains the Achilles heel of AF ablation: despite acute isolation, late PV reconnection results in AF recurrences [1]. Radio Frequency (RF) ablation is the most widely used ablation technique. The versatility of this ablation strategy enables operators to tailor the treatment according to anatomical and tissue variability. The Carto Smart Touch™ Technology increases the success rate of Paroxysmal AF procedure with freedom of AF at 1-year follow-up. Recent studies have shown improved clinical outcomes with use of Regional Ablation Index (AI) targets for PVI [2]. Different studies [3-5] have demonstrated > 82% up to 94% success rate. They highlight the minimum AI value for posterior/anterior wall to prevent reconnection. AI value > 400 might result in durable isolation. Sometimes it costs an overshoot observing complications as cardiac perforation. For this reason, all Atrial Fibrillation (AF) procedures performed with Carto® 3 advanced 3D mapping system and a Thermocouple Smart Touch® ablation catheter was analyzed retrospectively. In all cases ablation was done following the conventional linear Force-Time Interval (FTI). For each case AI measurement at each ablation point was estimated retrospectively. In one case a post-procedure complication occurred.
Authors and Affiliations
Domenico Grieco, Ermenegildo De Ruvo, Antonio Scarà, Leonardo Calo
Keywords
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- EP ID EP584609
- DOI 10.26717/BJSTR.2018.11.002179
- Views 149
- Downloads 0
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