Abstract
Background
A point-by-point workflow for pulmonary vein isolation (PVI) targeting pre-defined Ablation Index values (a composite of contact force, time and power) and minimising interlesion distance may optimise the creation of contiguous ablation lesions whilst minimising scar formation. We aimed to compare ablation scar formation in patients undergoing PVI using this workflow to patients undergoing a continuous catheter drag workflow.
Methods
Post-ablation Cardiovascular Magnetic Resonance (CMR) imaging was performed in patients undergoing 1st time PVI using a parameter-guided point-by-point workflow (n=26). Total left atrial scar burden and the width and continuity of the pulmonary vein encirclement were determined on analysis of atrial late gadolinium enhancement sequences. Comparison was made with a cohort of patients (n=20) undergoing PVI using continuous drag lesions.
Results
Mean post ablation scar burden and scar width were significantly lower in the point-by-point vs. the control group (6.66.8% vs. 9.65.0%, P=0.03 and 7.93.6mm vs. 10.72.3mm, P=0.003). More complete bilateral pulmonary vein encirclements were seen in the point-by-point group (P=0.038). All patients achieved acute pulmonary vein isolation.
Conclusion
PVI using a point-by-point workflow is feasible and results in a lower scar burden and scar width with more complete pulmonary vein encirclements than a conventional drag lesion approach.
A point-by-point workflow for pulmonary vein isolation (PVI) targeting pre-defined Ablation Index values (a composite of contact force, time and power) and minimising interlesion distance may optimise the creation of contiguous ablation lesions whilst minimising scar formation. We aimed to compare ablation scar formation in patients undergoing PVI using this workflow to patients undergoing a continuous catheter drag workflow.
Methods
Post-ablation Cardiovascular Magnetic Resonance (CMR) imaging was performed in patients undergoing 1st time PVI using a parameter-guided point-by-point workflow (n=26). Total left atrial scar burden and the width and continuity of the pulmonary vein encirclement were determined on analysis of atrial late gadolinium enhancement sequences. Comparison was made with a cohort of patients (n=20) undergoing PVI using continuous drag lesions.
Results
Mean post ablation scar burden and scar width were significantly lower in the point-by-point vs. the control group (6.66.8% vs. 9.65.0%, P=0.03 and 7.93.6mm vs. 10.72.3mm, P=0.003). More complete bilateral pulmonary vein encirclements were seen in the point-by-point group (P=0.038). All patients achieved acute pulmonary vein isolation.
Conclusion
PVI using a point-by-point workflow is feasible and results in a lower scar burden and scar width with more complete pulmonary vein encirclements than a conventional drag lesion approach.
| Original language | English |
|---|---|
| Journal | EUROPACE |
| Volume | 21 |
| Issue number | 12 |
| Early online date | 5 Sept 2019 |
| DOIs | |
| Publication status | Published - Dec 2019 |