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Impact of inter-lesion distance and first-pass isolation on outcomes of pulmonary venous isolation for paroxysmal atrial fibrillation

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Abstract

Background

Contiguity of ablation lesions is a critical determinant of success for paroxysmal atrial fibrillation (PAF) ablation. Evidence supports maintaining an inter-lesional distance (ILD) ≤ 6 mm during pulmonary venous isolation (PVI). Meanwhile, first-pass isolation (FPI) on PVI outcome in follow-up was not deeply studied. The impact of ILD and FPI on PAF ablation outcomes was investigated.

Methods

Consecutive PAF patients who underwent first-time antral PVI were recruited. Coordinates of ablation points were extracted from the electro-anatomical mapping system and analyzed using custom-developed software to determine the ILD. A gap is defined as ILD greater than 6 mm. FPI was defined as the achievement of PVI by encircling the ipsilateral veins while simultaneously recording their electrical activity using a multipolar catheter. The primary endpoint was freedom from documented atrial arrhythmias including AF, atrial tachycardia (AT), or atrial flutter (AFL) lasting longer than 30 s during follow-up.

Results

A total of 105 patients underwent first-time antral PVI. During 13.3 ± 0.6 months of follow-up, atrial arrhythmias recurrence was noted in 22.9% of the patients. Atrial arrhythmia recurrence was significantly higher in patients with more gaps (> 2) (37.0% versus 11.9%, P < 0.01), and the number of gaps was an independent predictor of AF/AT/AFL recurrence. (Hazard ratio [HR] 1.20, 95% CI 1.03–1.40, P = 0.02). The group with FPI for at least one ipsilateral pair of PVs exhibited a decreased number of gaps (2.0 versus 7.0, P < 0.01) and demonstrated a significant correlation with a reduction of recurrence (HR 0.26, 95% CI 0.09–0.71, P = 0.01). Among 16 patients who underwent repeat ablation, the number of gaps during the index PVI was associated with PV reconnection (PVR) (P < 0.01).

Conclusions

Gaps created during PVI are a modifiable determinant of AF/AT/AFL recurrence, and avoidance of gaps is crucial to improve clinical outcomes of PAF ablation. In addition, FPI exhibited a strong predictive capability for clinical success in patients with PAF.

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If there is a reasonable request, all the data can be obtained through the corresponding author.

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Funding

This study was funded by the 6th phase 333 project of Jiangsu Province (2022–2-408). Zhongnanshan Medical Foundation of Guangdong Province: ZNSA 2020017.

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Author notes

  1. Dan Bo, Dongsheng Zhao, Yan Dong, Qiushi Chen and Nishant Yadav have contributed equally to this work.

Authors and Affiliations

  1. Electrophysiology and Pacing Unit, Department of Cardiology, The First Affiliated Hospital With Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China

    Dan Bo, Dongsheng Zhao, Yan Dong, Wei Zhao, Qiushi Chen, Nishant Yadav & Fengxiang Zhang

  2. National University of Singapore, Asian Heart and Vascular Centre, Singapore, Singapore

    Pipin Kojodjojo

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  1. Dan Bo
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  2. Dongsheng Zhao
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Correspondence to Fengxiang Zhang.

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The study was carried out in accordance with the principles of the Declaration of Helsinki and was approved by all local Ethics Committees. All subjects were given written informed consent before participating in the study.

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Bo, D., Zhao, D., Dong, Y. et al. Impact of inter-lesion distance and first-pass isolation on outcomes of pulmonary venous isolation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol (2024). https://doi.org/10.1007/s10840-024-01810-1

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