Home > Personalised pulmonary vein isolation procedure feasible and effective

Personalised pulmonary vein isolation procedure feasible and effective

Presented by
Dr Cheryl Terés, Teknon Medical Centre, Spain
Conference
EHRA 2021
Trial
Ablate-by-LAW
The Ablate-by-LAW study evaluated a personalised pulmonary vein isolation procedure adapting the ablation index to the left atrial wall thickness. The method was shown to be feasible and effective while posing a less demanding ablation protocol.

The main reason for the recurrence of paroxysmal atrial fibrillation (AF) is pulmonary vein (PV) reconnection. The creation of more efficient lesion creation and durable PV isolation was aided by the development of the ablation index. The left atrium is a thin structure with only 1-5mm wall thickness, and wall thickness is an independent predictor for PV reconnection. The aim of the Ablate-by-LAW study (NCT04218604) was to determine the efficacy, safety, and feasibility of adapting the ablation index to the left atrial wall thickness (LAWT).

The Ablate-by LAW study included multi-detector spiral computed tomography (MDCT)-derived LAWT, the MDCT-derived 3D ‘fingerprinted’ oesophagus image, a single-catheter strategy, and general anaesthesia with high-rate low-volume ventilation. Power settings and targeted ablation index were adapted to LAWT, which was categorised into 5 different thickness ranges. Furthermore, the distance between the oesophagus and the left atrial posterior wall was mapped and the lesion personalised by trying to avoid ablation through the closest part.

Dr Cheryl Terés (Teknon Medical Centre, Spain) presented results from 90 patients included in this study after a follow-up period of 11 months:


    • 4 out of 90 patients (4.5%) had recurrences documented by ECG or self-reported symptoms;
    • median procedural time was 1 hour;
    • median radiofrequency time was 14 minutes;
    • median fluoroscopy time was 0.75 minutes; and
    • median fluoroscopy dose area product was 1 mGy/m².

Dr Terés concluded that the feasibility of incorporating 3D LAWT maps was demonstrated and that it can be successfully used for PV isolation. Tailoring of delivered radiofrequency energy and ablation line design depending on wall thickness increased efficacy and showed a high rate of first-pass isolation. Furthermore, the recurrence rate was similar to previously reported protocols with lower procedural requirements.


    1. Teres C. et al. Personalized atrial fibrillation ablation by tailoring ablation index to the left atrial wall thickness: the ablate by-law single centre study. 2021 EHRA Congress, 23-25 April.

 



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