Prospective use of ablation index for the ablation of right ventricle outflow tract premature ventricular contractions: a proof of concept study
Articolo
Data di Pubblicazione:
2020
Citazione:
Prospective use of ablation index for the ablation of right ventricle outflow tract premature ventricular contractions: a proof of concept study / A. Gasperetti, R. Sicuso, A. Dello Russo, G. Zucchelli, A.M. Saguner, P. Notarstefano, E. Soldati, M.G. Bongiorni, D.G. Della Rocca, S. Mohanty, C. Carbucicchio, F. Duru, L. Di Biase, A. Natale, C. Tondo, M. Casella. - In: EUROPACE. - ISSN 1099-5129. - (2020). [Epub ahead of print] [10.1093/europace/euaa228]
Abstract:
Aims: Radiofrequency catheter ablation (RFCA) represents an effective option for idiopathic premature ventricular contractions (PVCs) treatment. Ablation Index (AI) is a novel ablation marker incorporating RF power, contact force, and time of delivery into a single weighted formula. Data regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was to compare AI-guided and standard RFCA outcomes in patients with PVCs originating from the right ventricle outflow tract (RVOT).
Methods and results: Consecutive patients undergoing AI-guided RFCA of RVOT idiopathic PVCs were prospectively enrolled. Radiofrequency catheter ablation was performed following per-protocol target cut-offs of AI, depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI cut-off: 610). A multi-centre cohort of propensity-matched (age, sex, ejection fraction, and PVC site) patients undergoing standard PVCs RFCA was used as a comparator. Sixty AI-guided patients (44.2 ± 18.0 years old, 58% male, left ventricular ejection fraction 56.2 ± 3.8%) were enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in the RVOT free wall area. Propensity match with 60 non-AI-guided patients was performed. Acute outcomes and complications resulted comparable. At 6 months, arrhythmic recurrence was more common in non-AI-guided patients whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation Index guidance was associated with improved survival from arrhythmic recurrence [overall odds ratio 6.61 (1.95-22.35), P = 0.001; RVOT septum 5.99 (1.21-29.65), P = 0.028; RVOT free wall 11.86 (1.12-124.78), P = 0.039].
Conclusion: Ablation Index-guidance in idiopathic PVCs ablation was associated with better arrhythmic outcomes at 6 months of follow-up.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
Ablation index; Catheter ablation; Idiopathic premature ventricular contractions; Right ventricle outflow tract; Ventricular arrhythmias
Elenco autori:
A. Gasperetti, R. Sicuso, A. Dello Russo, G. Zucchelli, A.M. Saguner, P. Notarstefano, E. Soldati, M.G. Bongiorni, D.G. Della Rocca, S. Mohanty, C. Carbucicchio, F. Duru, L. Di Biase, A. Natale, C. Tondo, M. Casella
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