학술논문
Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation.
Document Type
Academic Journal
Author
Boga M; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Orbán G; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Perge P; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Salló Z; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Tanai E; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Ferencz AB; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Tóth P; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Komlósi F; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Osztheimer I; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Nagy KV; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Merkely B; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Gellér L; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.; Szegedi N; Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary.
Source
Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101606588 Publication Model: Electronic Cited Medium: Print ISSN: 2077-0383 (Print) Linking ISSN: 20770383 NLM ISO Abbreviation: J Clin Med Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
2077-0383
Abstract
Background: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates and predictors of PVR. Methods: We retrospectively included 100 patients who underwent repeated ablation due to AF recurrence after initial PVI with the CARTO system. PVR was determined during the repeated procedure by electrophysiological evaluation, and initial procedural characteristics predicting PVR were studied, including adherence to the CLOSE protocol, use of high power, first-pass isolation (FPI), and baseline generator impedance (BGI). Results: Thirty-eight patients underwent initial CLOSE-guided PVI, and sixty-two underwent initial non-CLOSE PVI. A repeat procedure was performed 23 ± 16 months after the initial procedure. In total, PVR was found in 192 of 373 PVs (51.5%), and all PVs were isolated in 17/100 (17%) patients. Factors associated with all PVs being isolated were adherence to the CLOSE protocol, a higher power setting, the presence of bilateral FPI, and lower BGI (88% vs. 28%, p < 0.0001; 37.5 W vs. 30 W, p = 0.0276; 88.2% vs. 40.4%, p = 0.0007; and 127.6 Ω vs. 136.6 Ω, p = 0.0027, respectively). In initial procedures with adherence to the CLOSE protocol, the FPI rate was significantly higher (73.7% vs. 25%, p < 0.0001), while there were no significant differences in terms of procedure time and left atrial dwell time (81 vs. 85 min, p = 0.83; and 60 vs. 58 min, p = 0.08, respectively). BGI ≥ 130 Ω (AUC = 0.7403, sensitivity: 77.1%, specificity: 68.8%, p = 0.0032) was associated with a significantly higher probability of PVR (OR = 6.757; p < 0.0001). In multivariable analysis, independent predictors for PVR were non-adherence to the CLOSE protocol and BGI ≥ 130 Ω. Conclusions: Our findings indicate that adherence to the CLOSE protocol and baseline generator impedance < 130 Ω during AF ablation are independent predictors of PVI durability.