Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation

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  • dc.contributor.author Falasconi, Giulio
  • dc.contributor.author Penela, Diego
  • dc.contributor.author Soto-Iglesias, David
  • dc.contributor.author Francia, Pietro
  • dc.contributor.author Teres, Cheryl
  • dc.contributor.author Saglietto, Andrea
  • dc.contributor.author Jauregui, Beatriz
  • dc.contributor.author Viveros, Daniel
  • dc.contributor.author Bellido, Aldo
  • dc.contributor.author Alderete, Jose
  • dc.contributor.author Meca-Santamaria, Julia
  • dc.contributor.author Franco Ocaña, Paula
  • dc.contributor.author Gaspardone, Carlo
  • dc.contributor.author San Antonio, Rodolfo
  • dc.contributor.author Huguet, Marina
  • dc.contributor.author Camara, Oscar
  • dc.contributor.author Ortiz-Pérez, Jose-Tomás
  • dc.contributor.author Martí-Almor, Julio
  • dc.contributor.author Berruezo Sánchez, Antonio
  • dc.date.accessioned 2023-06-30T06:45:19Z
  • dc.date.available 2023-06-30T06:45:19Z
  • dc.date.issued 2023
  • dc.description.abstract Aims: Pulmonary vein (PV) antrum isolation proved to be effective for treating persistent atrial fibrillation (PeAF). We sought to investigate the results of a personalized approach aimed at adapting the ablation index (AI) to the local left atrial wall thickness (LAWT) in a cohort of consecutive patients with PeAF. Methods and results: Consecutive patients referred for PeAF first ablation were prospectively enrolled. The LAWT three-dimensional maps were obtained from pre-procedure multidetector computed tomography and integrated into the navigation system. Ablation index was titrated according to the local LAWT, and the ablation line was personalized to avoid the thickest regions while encircling the PV antrum. A total of 121 patients (69.4% male, age 64.5 ± 9.5 years) were included. Procedure time was 57 min (IQR 50–67), fluoroscopy time was 43 s (IQR 20–71), and radiofrequency (RF) time was 16.5 min (IQR 14.3–18.4). The median AI tailored to the local LAWT was 387 (IQR 360–410) for the anterior wall and 335 (IQR 300–375) for the posterior wall. First-pass PV antrum isolation was obtained in 103 (85%) of the right PVs and 103 (85%) of the left PVs. Median LAWT values were higher for PVs without first-pass isolation as compared to the whole cohort (P = 0.02 for left PVs and P = 0.03 for right PVs). Recurrence-free survival was 79% at 12 month follow-up. Conclusion: In this prospective study, LAWT-guided PV antrum isolation for PeAF was effective and efficient, requiring low procedure, fluoroscopy, and RF time. A randomized trial comparing the LAWT-guided ablation with the standard of practice is in progress (ClinicalTrials.gov, NCT05396534).
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Falasconi G, Penela D, Soto-Iglesias D, Francia P, Teres C, Saglietto A, Jauregui B, Viveros D, Bellido A, Alderete J, Meca-Santamaria J, Franco P, Gaspardone C, San Antonio R, Huguet M, Cámara Ó, Ortiz-Pérez JT, Martí-Almor J, Berruezo A. Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation. Europace. 2023;25(5):euad118. DOI: 10.1093/europace/euad118
  • dc.identifier.doi http://dx.doi.org/10.1093/europace/euad118
  • dc.identifier.issn 1099-5129
  • dc.identifier.uri http://hdl.handle.net/10230/57421
  • dc.language.iso eng
  • dc.publisher Oxford University Press
  • dc.relation.ispartof EP Europace. 2023;25(5):euad118.
  • dc.rights © The Author(s) 2023. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
  • dc.subject.keyword Persistent atrial fibrillation
  • dc.subject.keyword Left atrial wall thickness
  • dc.subject.keyword Catheter ablation
  • dc.subject.keyword Pulmonary vein isolation
  • dc.subject.keyword Multidetector cardiac tomography
  • dc.title Personalized pulmonary vein antrum isolation guided by left atrial wall thickness for persistent atrial fibrillation
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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