Prospective use of ablation index for the ablation of right ventricle outflow tract premature ventricular contractions: A proof of concept study

Alessio Gasperetti, Rita Sicuso, Antonio Dello Russo, Giulio Zucchelli, Ardan Muammer Saguner, Pasquale Notarstefano, Ezio Soldati, Maria Grazia Bongiorni, Domenico Giovanni Della Rocca, Sanghamitra Mohanty, Corrado Carbucicchio, Firat Duru, Luigi Di Biase, Andrea Natale, Claudio Tondo, Michela Casella

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Aims: Radiofrequency catheter ablation (RFCA) represents an effective option for idiopathic premature ventricular contractions (PVCs) treatment. Ablation Index (AI) is a novel ablation marker incorporating RF power, contact force, and time of delivery into a single weighted formula. Data regarding AI-guided PVCs RFCA are currently lacking. Aim of the study was to compare AI-guided and standard RFCA outcomes in patients with PVCs originating from the right ventricle outflow tract (RVOT). Methods and results: Consecutive patients undergoing AI-guided RFCA of RVOT idiopathic PVCs were prospectively enrolled. Radiofrequency catheter ablation was performed following per-protocol target cut-offs of AI, depending on targeted area (RVOT free wall AI cut-off: 590; RVOT septum AI cut-off: 610). A multi-centre cohort of propensity-matched (age, sex, ejection fraction, and PVC site) patients undergoing standard PVCs RFCA was used as a comparator. Sixty AI-guided patients (44.2 ± 18.0 years old, 58% male, left ventricular ejection fraction 56.2 ± 3.8%) were enrolled; 34 (57%) were ablated in RVOT septum and 26 (43%) patients in the RVOT free wall area. Propensity match with 60 non-AI-guided patients was performed. Acute outcomes and complications resulted comparable. At 6 months, arrhythmic recurrence was more common in non-AI-guided patients whether in general (28% vs. 7% P = 0.003) or by ablated area (RVOT free wall: 27% vs. 4%, P = 0.06; RVOT septum 29% vs. 9% P = 0.05). Ablation Index guidance was associated with improved survival from arrhythmic recurrence [overall odds ratio 6.61 (1.95-22.35), P = 0.001; RVOT septum 5.99 (1.21-29.65), P = 0.028; RVOT free wall 11.86 (1.12-124.78), P = 0.039]. Conclusion: Ablation Index-guidance in idiopathic PVCs ablation was associated with better arrhythmic outcomes at 6 months of follow-up.

Original languageEnglish (US)
Pages (from-to)91-98
Number of pages8
JournalEuropace
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2021
Externally publishedYes

Keywords

  • Ablation index
  • Catheter ablation
  • Idiopathic premature ventricular contractions
  • Right ventricle outflow tract
  • Ventricular arrhythmias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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