Local impedance drop guided versus lesion size index guided pulmonary vein isolation: long-term outcomes and chronic reconnections

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Insufficient lesion depth and discontinuity lines are reasons for reconnections after point-by-point radiofrequent pulmonary vein isolation (PVI). Different technologies have shown to be useful prediction effective lesions. Measurement the magnitude local tissue impedance drop (LID) calculation size index (LSI) based on monitoring contact force examples corresponding technologies. Purpose To compare long-term outcomes LID guided with LSI PVI. Methods In this retrospective study we compared two groups patients who underwent radiofrequency PVI treatment atrial fibrillation. LID-guided group (n=35) energy was delivered using an ablation catheter monitoring. Ablation terminated when reached a plateau (Fig. A). LSI-guided (n=31) lesions were created until target in each point (LSI=5 anterior LSI=4 posterior segments, respectively, Fig B). The inter-lesion distance <6 mm power 40 W 30W segments used both groups. A gap-map touch-up performed along line if first pass did not occur, or case acute reconnection 20 min waiting time. follow-up, holter ECG scheduled 3, 6 12 months initial as well symptom-driven visits registration. symptomatic arrhythmia recurrence, second procedure including validation PVI, mapping site RePVI, necessary. Results All veins successfully isolated by encirclement ipsilateral during procedure. During 11.5±2.9 out 35 (34.3%) from 5 31 (16.1%) experienced recurrence. Kaplan-Meier survival analysis showed statistically significant higher probability recurrence treated approach (log-rank=4.37, p=0.037, C). Redo 10 (28.6%) 3 (9.7%) chronic detected 7 (70%) 2 (67%) patients, respectively (Fig D). Conclusions Despite successful all veins, resulted significantly follow-up rate PV (although significant) ablation. This reflects nature anticipating quality catheter-tissue interface before application, which is possible only approach.