Ablation-index guided versus conventional contact-force guided ablation in pulmonary vein isolation – Systematic review and meta-analysis

BACKGROUND: Contact-force sensing catheter is widely used for catheter ablation, however, it did not take account of radiofrequency power. Ablation index (AI) is a novel marker incorporating contact force-time-power, was shown to be reliable in predicting lesion size and depth for radiofrequency delivery. We aimed to assess the latest evidence on ablation index guided procedure versus conventional ablation procedure. METHODS: We performed a comprehensive search on topic that assesses ablation index guided procedure versus conventional procedures from inception up until February 2019 through PubMed, EuropePMC, EBSCOhost, Cochrane Central Database, and ClinicalTrials.gov. RESULTS: A total of 1727 subjects from five studies were included. 12 months’ incidence of AF/AT/AFL was lower in ablation index guided with an OR of 0.35 [0.17, 0.73], p = 0.005; I(2) 58%. Upon sensitivity analysis by removing a study, heterogeneity decreased to 0% with OR of 0.26 [0.15, 0.46], p < 0.001. First-pass isolation has a pooled OR of 11.29 [4.68, 27.20], p < 0.001; I(2) 58%. Pooled OR for acute pulmonary vein reconnection was 0.43 [0.29, 0.64], p < 0.001; I(2) 46%. AI group has a shorter fluoroscopy time of MD -1.62 [-2.62, −0.62] minutes, p = 0.001; I(2) 51% and total ablation time MD -9.96 [-17.16, −2.76] minutes, p < 0.001; I(2) 95%. Total procedural time and complication rate were similar. CONCLUSION: Ablation index guided procedure resulted in a significantly lower incidence of AF/AT/AFL, shorter fluoroscopy time, and total ablation time. First-pass isolation was higher in AI group and acute PVR was lower in AI group. Ablation-index guided procedure has a similar safety profile to conventional ablation.