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Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation

BACKGROUND: High power-ablation index (HP-AI)-guided ablation for atrial fibrillation (AF) targeting high AIs has been implemented in European countries. However, milder AI targets are widely used in Asia. The safety and efficacy of HP-AI-guided ablation compared with those of low-power AI-guided ab...

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Autores principales: Liu, Zheng, Liu, Li-feng, Liu, Xiao-qin, Liu, Jiapeng, Wang, Yu-xin, Liu, Ye, Liu, Xing-peng, Yang, Xin-chun, Chen, Mu-lei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387669/
https://www.ncbi.nlm.nih.gov/pubmed/35990990
http://dx.doi.org/10.3389/fcvm.2022.949918
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author Liu, Zheng
Liu, Li-feng
Liu, Xiao-qin
Liu, Jiapeng
Wang, Yu-xin
Liu, Ye
Liu, Xing-peng
Yang, Xin-chun
Chen, Mu-lei
author_facet Liu, Zheng
Liu, Li-feng
Liu, Xiao-qin
Liu, Jiapeng
Wang, Yu-xin
Liu, Ye
Liu, Xing-peng
Yang, Xin-chun
Chen, Mu-lei
author_sort Liu, Zheng
collection PubMed
description BACKGROUND: High power-ablation index (HP-AI)-guided ablation for atrial fibrillation (AF) targeting high AIs has been implemented in European countries. However, milder AI targets are widely used in Asia. The safety and efficacy of HP-AI-guided ablation compared with those of low-power AI-guided ablation in a milder AI-targeting setting are unknown. The goal of this study was to explore the efficacy and safety of HP-AI-guided ablation in a milder AI-targeting setting. METHODS: Patients who underwent pulmonary vein isolation (PVI) for AI-guided atrial fibrillation ablation in our center were enrolled and divided into 2 groups according to the ablation power used. In the HP-AI group, the ablation power was over 45 W, while the low power-AI group was ablated with <35 W power. The targeted AIs were 450–500 in the anterior wall and 350–400 in the posterior wall. The efficacy outcome was expressed as the single-procedure atrial arrhythmia-free survival between 91 days and 1 year. Safety outcomes included severe adverse events (SAEs), including symptomatic pulmonary vein (PV) stenosis, atrioesophagal fistula, cardiac tamponade, stroke, thromboembolism events, myocardial infarction, and major bleeding. RESULTS: A total of 134 patients were enrolled, of whom 74 underwent PVI using HP-AI, while 60 received low power-AI ablation. After a mean follow-up time of 7.4 months, 22 (16.4%) patients showed arrhythmia recurrence: 5 (6.8%) patients in the HP-AI group and 17 (28.3%) patients in the low power-AI group. The HP-AI group showed a significantly higher arrhythmia-free survival than the low power-AI group (p = 0.011). Two patients in the low power-AI group and 1 patient in the HP-AI group developed an SAE (p = NS). Compared with the low power-AI group, the HP-AI group demonstrated a higher PV first-pass isolation rate, shorter ablation time, and fewer patients with anatomical leakages and sites of unreached AI. CONCLUSION: In a milder AI setting, HP-AI ablation might result in significantly higher arrhythmia-free survival than low power-AI ablation and a similar safety profile.
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spelling pubmed-93876692022-08-19 Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation Liu, Zheng Liu, Li-feng Liu, Xiao-qin Liu, Jiapeng Wang, Yu-xin Liu, Ye Liu, Xing-peng Yang, Xin-chun Chen, Mu-lei Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: High power-ablation index (HP-AI)-guided ablation for atrial fibrillation (AF) targeting high AIs has been implemented in European countries. However, milder AI targets are widely used in Asia. The safety and efficacy of HP-AI-guided ablation compared with those of low-power AI-guided ablation in a milder AI-targeting setting are unknown. The goal of this study was to explore the efficacy and safety of HP-AI-guided ablation in a milder AI-targeting setting. METHODS: Patients who underwent pulmonary vein isolation (PVI) for AI-guided atrial fibrillation ablation in our center were enrolled and divided into 2 groups according to the ablation power used. In the HP-AI group, the ablation power was over 45 W, while the low power-AI group was ablated with <35 W power. The targeted AIs were 450–500 in the anterior wall and 350–400 in the posterior wall. The efficacy outcome was expressed as the single-procedure atrial arrhythmia-free survival between 91 days and 1 year. Safety outcomes included severe adverse events (SAEs), including symptomatic pulmonary vein (PV) stenosis, atrioesophagal fistula, cardiac tamponade, stroke, thromboembolism events, myocardial infarction, and major bleeding. RESULTS: A total of 134 patients were enrolled, of whom 74 underwent PVI using HP-AI, while 60 received low power-AI ablation. After a mean follow-up time of 7.4 months, 22 (16.4%) patients showed arrhythmia recurrence: 5 (6.8%) patients in the HP-AI group and 17 (28.3%) patients in the low power-AI group. The HP-AI group showed a significantly higher arrhythmia-free survival than the low power-AI group (p = 0.011). Two patients in the low power-AI group and 1 patient in the HP-AI group developed an SAE (p = NS). Compared with the low power-AI group, the HP-AI group demonstrated a higher PV first-pass isolation rate, shorter ablation time, and fewer patients with anatomical leakages and sites of unreached AI. CONCLUSION: In a milder AI setting, HP-AI ablation might result in significantly higher arrhythmia-free survival than low power-AI ablation and a similar safety profile. Frontiers Media S.A. 2022-08-04 /pmc/articles/PMC9387669/ /pubmed/35990990 http://dx.doi.org/10.3389/fcvm.2022.949918 Text en Copyright © 2022 Liu, Liu, Liu, Liu, Wang, Liu, Liu, Yang and Chen. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Liu, Zheng
Liu, Li-feng
Liu, Xiao-qin
Liu, Jiapeng
Wang, Yu-xin
Liu, Ye
Liu, Xing-peng
Yang, Xin-chun
Chen, Mu-lei
Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation
title Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation
title_full Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation
title_fullStr Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation
title_full_unstemmed Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation
title_short Ablation index-guided ablation with milder targets for atrial fibrillation: Comparison between high power and low power ablation
title_sort ablation index-guided ablation with milder targets for atrial fibrillation: comparison between high power and low power ablation
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9387669/
https://www.ncbi.nlm.nih.gov/pubmed/35990990
http://dx.doi.org/10.3389/fcvm.2022.949918
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