Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-152 - Ablation Index Adjusted To Local Wall Thickness Is Associated With Acute Pulmonary Vein Reconnection After Ablation Index-guided Ablation (ID 228)


Background: Ablation Index (AI)-guided ablation allows for the creation of ablation lesions of consistent depth.
Objective: The present study aimed to determine the predictive value of AI adjusted to local atrial wall thickness for acute pulmonary vein reconnection after AI-guided AF ablation.
Methods: Consecutive patients who underwent cardiac CT imaging prior to AI-guided AF ablation between December 2017 and September 2019 were studied. AI targets were 500 for anterior/roof and 380 for posterior/inferior segments with maximum interlesion distance of 6 mm. Minimum AI, force-time integral (FTI) and impedance drop were assessed for each segment according to a 16-segment model. Atrial wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units. ROC curve analysis was performed to calculate the predictive value of minimum impedance drop, minimum FTI, minimum AI, and minimum AI adjusted to local wall thickness (AI/wall thickness) for acute reconnection.
Results: Study population consisted of 70 AF patients (63% paroxysmal AF, 67% male, mean age 63±8 years). Acute reconnection occurred in 27/1120 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 19/140 (14%) ablation circles. ROC curve analysis revealed that minimum FTI, minimum impedance drop and unadjusted minimum AI could not discriminate between segments with and without acute reconnection. Minimum AI adjusted to local wall thickness was a significant predictor of acute reconnection (AUC=0.783; p<0.001).
Conclusion: AI adjusted to local wall thickness is associated with acute pulmonary vein reconnection after Ablation Index-guided ablation.