Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Cardiovasc Electrophysiol. 2023 Sep;34(9):1811-1819. doi: 10.1111/jce.16026. Epub 2023 Aug 18.
Although left atrial wall thickness (LAWT) is known to be varied, a fixed target Ablation Index (AI) based pulmonary vein isolation (PVI) has been suggested in catheter ablation for atrial fibrillation (AF). We aimed to evaluate the efficacy and safety of PVI applying tailored AI based on LAWT assessed by cardiac computed tomography (CT).
The thick segment was defined as the segment including ≥LAWT grade 3 (≥1.5 mm). The fixed AI strategy was defined as AI targets were 450 on the anterior/roof segments and 350 on the posterior/inferior/carina segments regardless of LAWT. The tailored AI strategy consisted of AI increasing the targets to 500 on the anterior/roof segments and to 400 on the posterior/inferior/carina segments when ablating the thick segment. After PVI, acute pulmonary vein (PV) reconnection, defined by the composite of residual potential and early reconnection, was evaluated.
A total of 156 patients (paroxysmal AF 72%) were consecutively included (86 for the fixed AI group and 70 for the tailored AI group). The tailored AI group showed a significantly lower rate of segments with acute PV reconnection than the fixed AI group (8% vs. 5%, p = .007). The tailored AI group showed a trend for shorter ablation time for PVI. One-year AF/atrial tachycardia free survival rate was similar in two groups (87.2% in the fixed AI group and 90.0% in the tailored AI group, p = .606).
Applying tailored AI based on the LAWT was a feasible and effective strategy to reduce acute PV reconnection after PVI.
尽管已知左心房壁厚度（LAWT）存在差异，但在导管消融治疗心房颤动（AF）中，已经提出了基于固定消融指数（AI）的肺静脉隔离（PVI）。我们旨在评估基于心脏计算机断层扫描（CT）评估的 LAWT 应用定制 AI 的 PVI 的疗效和安全性。
厚节段定义为包括≥LAWT 3 级（≥1.5mm）的节段。固定 AI 策略定义为，无论 LAWT 如何，前/顶段的 AI 目标为 450，后/下/隆凸段的 AI 目标为 350。定制 AI 策略包括在前/顶段消融厚节段时将 AI 目标增加到 500，在后/下/隆凸段将 AI 目标增加到 400。PVI 后，通过残余电势和早期再连接的组合评估急性肺静脉（PV）再连接。
共连续纳入 156 例患者（阵发性 AF 72%）（固定 AI 组 86 例，定制 AI 组 70 例）。定制 AI 组的急性 PV 再连接节段发生率明显低于固定 AI 组（8%比 5%，p=0.007）。定制 AI 组的 PVI 消融时间有缩短的趋势。两组 1 年 AF/房性心动过速无复发生存率相似（固定 AI 组为 87.2%，定制 AI 组为 90.0%，p=0.606）。
基于 LAWT 的应用定制 AI 是一种可行且有效的策略，可以降低 PVI 后急性 PV 再连接的发生率。
