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07.10.2020 | Original articles

Influence of ablation index on the incidence of cardiac tamponade complicating pulmonary vein isolation

verfasst von: Nico Reinsch, MD, FESC, Anna Füting, MD, Jochen Buchholz, MD, Ute Ruprecht, MD, Kars Neven, MD, PhD, FEHRA

Erschienen in: Herz | Sonderheft 2/2021

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Abstract

Background

Cardiac tamponade (CT) complicating pulmonary vein isolation (PVI) for atrial fibrillation (AF) is a complication that can increase morbidity and mortality. Radiofrequency energy is a known cause of CT. Ablation Index (AI) is a novel ablation quality marker. We hypothesized that use of AI reduces the incidence of CT.

Methods

All AF procedures between 10/2014 and 06/2019 were included. Three ablation groups were defined: group A, RF ablation with non-contact force (CF) catheter; group B, RF ablation with CF catheter; and group C, RF ablation with CF catheter using AI. All episodes of CT were analyzed.

Results

In total, 1222 consecutive AF patients underwent PVI. Group A consisted of 100 (8%) procedures, while group B included 432 (35%) procedures and group C 690 (57%) procedures. The overall risk for CT in all patients was 2.1% (26/1222). The risk in group A was 2.9% (3/100), in group B 2.5% (11/432), and in group C 1.7% (12/690), including all 1222 patients in the analysis (p < 0.05). Univariate analysis identified no further specific predictors for CT. With the exception of one patient (1/26; 3.8%), who needed surgical treatment, all CT could be successfully drained.

Conclusions

In a high-volume center, the use of AI decreased the risk of CT in patients undergoing RF ablation for AF by 32%.

Kirchhof P, Benussi S, Kotecha D et al (2016) 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 18:1609–1678CrossRef

Steinbeck G, Sinner MF, Lutz M et al (2018) Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014. Eur Heart J 39:4020–4029CrossRef

Cappato R, Calkins H, Chen SA et al (2009) Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol 53:1798–1803CrossRef

Kautzner J, Neuzil P, Lambert H et al (2015) EFFICAS II: optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation. Europace 17:1229–1235CrossRef

Conti S, Weerasooriya R, Novak P et al (2018) Contact force sensing for ablation of persistent atrial fibrillation: a randomized, multicenter trial. Heart Rhythm 15:201–208CrossRef

Phlips T, Taghji P, El Haddad M et al (2018) Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’-protocol. Europace 20:f419–f427

Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber Quantification writing group, developed in conjunction with the European association of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr 18:1440–1463CrossRef

Stabile G, Di Donna P, Schillaci V et al (2017) Safety and efficacy of pulmonary vein isolation using a surround flow catheter with contact force measurement capabilities: a multicenter registry. J Cardiovasc Electrophysiol 28:762–767CrossRef

Chun KRJ, Perrotta L, Bordignon S et al (2017) Complications in catheter ablation of atrial fibrillation in 3,000 consecutive procedures: balloon versus radiofrequency current ablation. JACC Clin Electrophysiol 3:154–161CrossRef

10.

Belhassen B (2009) A 1 per 1,000 mortality rate after catheter ablation of atrial fibrillation: an acceptable risk. J Am Coll Cardiol 53(19):1804CrossRef

11.

Morillo CA, Verma A, Connolly SJ et al (2014) Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA 311:692–700CrossRef

12.

Arbelo E, Brugada J, Blomström-Lundqvist C et al (2017) Contemporary management of patients undergoing atrial fibrillation ablation: in-hospital and 1‑year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry. Eur Heart J 38:1303–1316PubMed

13.

Chen J, Dagres N, Hocini M et al (2015) Catheter ablation for atrial fibrillation: results from the first European snapshot survey on procedural routines for atrial fibrillation ablation (ESS-PRAFA) part II. Europace 17:1727–1732CrossRef

14.

Kuck KH, Reddy VY, Schmidt B et al (2012) A novel radiofrequency ablation catheter using contact force sensing: Toccata study. Heart Rhythm 9:18–23CrossRef

15.

Natale A, Reddy VY, Monir G et al (2014) Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial. J Am Coll Cardiol 64:647–656CrossRef

16.

Solimene F, Schillaci V, Shopova G et al (2019) Safety and efficacy of atrial fibrillation ablation guided by ablation index module. J Interv Card Electrophysiol 54:9–15CrossRef

17.

Verma A, Jiang CY, Betts TR et al (2015) Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med 372:1812–1822CrossRef

18.

Santoro F, Metzner A, Brunetti ND et al (2019) Left atrial anterior line ablation using ablation index and inter-lesion distance measurement. Clin Res Cardiol 108(9):1009–1016. https://doi.org/10.1007/s00392-019-01428-8CrossRefPubMed

19.

Chen S, Schmidt B, Bordignon S et al (2019) Ablation index-guided 50 W ablation for pulmonary vein isolation in patients with atrial fibrillation: procedural data, lesion analysis, and initial results from the FAFA AI high power study. J Cardiovasc Electrophysiol 30:2724–2731CrossRef

20.

Kottmaier M, Popa M, Bourier F et al (2019) Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Europace 22(3):388–393. https://doi.org/10.1093/europace/euz342CrossRef

21.

Barkagan M, Contreras-Valdes FM, Leshem E et al (2018) High-power and short-duration ablation for pulmonary vein isolation: safety, efficacy, and long-term durability. J Cardiovasc Electrophysiol 29:1287–1296CrossRef

22.

Leshem E, Zilberman I, Tschabrunn CM et al (2018) High-power and short-duration ablation for pulmonary vein isolation: biophysical characterization. JACC Clin Electrophysiol 4:467–479CrossRef

23.

Reddy VY, Grimaldi M, De Potter T et al (2019) Pulmonary vein isolation with very high power, short duration, temperature-controlled lesions the QDOT-fast trial. JACC Clin Electrophysiol 5(7):778–786CrossRef

24.

Calzolari V, De Mattia L, Indiani S et al (2017) In vitro validation of the lesion size index to predict lesion width and depth after irrigated radiofrequency ablation in a porcine model. JACC Clin Electrophysiol 3:1126–1135CrossRef

25.

Sundaram S, Choe W, Jordan JR et al (2018) Two year, single center clinical outcome after catheter ablation for paroxysmal atrial fibrillation guided by lesion index. J Atr Fibrillation 11:1760CrossRef

26.

Reddy VY, Dukkipati SR, Neuzil P et al (2015) Randomized, controlled trial of the safety and effectiveness of a contact force-sensing irrigated catheter for ablation of paroxysmal atrial fibrillation: results of the TactiCath contact force ablation catheter study for atrial fibrillation (TOCCASTAR) study. Circulation 132:907–915CrossRef

27.

Aldhoon B, Wichterle D, Peichl P et al (2013) Complications of catheter ablation for atrial fibrillation in a high-volume centre with the use of intracardiac echocardiography. Europace 15:24–32CrossRef

28.

Di Biase L, Lakkireddy D, Trivedi C et al (2015) Feasibility and safety of uninterrupted periprocedural apixaban administration in patients undergoing radiofrequency catheter ablation for atrial fibrillation: results from a multicenter study. Heart Rhythm 12:1162–1168CrossRef

29.

Lakkireddy D, Reddy YM, Di Biase L et al (2012) Feasibility and safety of dabigatran versus warfarin for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry. J Am Coll Cardiol 59:1168–1174CrossRef

30.

Lakkireddy D, Reddy YM, Di Biase L et al (2014) Feasibility and safety of uninterrupted rivaroxaban for periprocedural anticoagulation in patients undergoing radiofrequency ablation for atrial fibrillation: results from a multicenter prospective registry. J Am Coll Cardiol 63:982–988CrossRef

Titel: Influence of ablation index on the incidence of cardiac tamponade complicating pulmonary vein isolation
verfasst von: Nico Reinsch, MD, FESC
Anna Füting, MD
Jochen Buchholz, MD
Ute Ruprecht, MD
Kars Neven, MD, PhD, FEHRA
Publikationsdatum: 07.10.2020
Verlag: Springer Medizin
Erschienen in: Herz / Ausgabe Sonderheft 2/2021
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-020-04988-y

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Background

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Conclusions

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