SpringerLink
Log in

The target ablation index values for electrical isolation of the superior vena cava

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

The ablation index (AI), developed as a radiofrequency (RF) catheter ablation composite component endpoint, which incorporates contact force (CF), time, and power in a weighted formula, has been reported to be useful for a durable pulmonary vein isolation (PVI) to treat atrial fibrillation (AF). No study has reported the target AI value for the SVC isolation (SVCI). In this study, we aimed to investigate the target AI for the SVCI.

Methods

Thirty-six AF patients who underwent an initial SVCI were enrolled. Ablation was performed at 556 points. The sites where dormant conduction was induced or additional ablation was needed were defined as touch up sites (n = 36). We compared the energy deliver time, power, generator impedance (GI) drop, local bipolar voltage, contact force (CF), force–time integral (FTI), and AI between the touch up sites and the no touch up sites (n = 520).

Results

The FTI and AI were significantly lower at the touch up sites (touch up sites vs. no touch up sites; FTI, 126.5 [99.3–208.8] vs. 244 [184–340.8], p < 0.0001; AI, 350.1 ± 43.6 vs. 277.2 ± 21.8, p < 0.0001). The median value of the AI at the no touch up sites was 350, and no reconnections were seen where the minimum AI value was more than 308. Most of the touch up sites were located in the anterior wall and lateral wall (anterior wall, 20/36 sites [55.6%]; lateral wall, 10/36 sites [27.8%]; septal wall, 6/36 sites [16.7%]; posterior wall, 0/36sites [0.0%]).

Conclusion

The target AI value for the SVCI should be 350, and at least 308 would be needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of data and material

Available upon request.

Code availability

Available upon request.

References

  1. Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659–66.

    Article  CAS  Google Scholar 

  2. Terasawa T, Balk EM, Chung M, et al. Systematic review: comparative effectiveness of radiofrequency catheter ablation for atrial ablation. Ann Intern Med. 2009;151:191–202.

    Article  Google Scholar 

  3. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017;14(10):e275–444.

    Article  Google Scholar 

  4. Goya M, Ouyang F, Ernst S, et al. Electroanatomic map** and catheter ablation of breakthroughs from the right atrium to the superior vena cava in patients with atrial fibrillation. Circulation. 2002;106:1317–20.

    Article  Google Scholar 

  5. Cappato R, Negroni S, Pecora D, et al. Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation. 2003;108(13):1599–604.

    Article  Google Scholar 

  6. Gerstenfeld EP, Callans DJ, Dixit S, et al. Incidence and location of focal atrial fibrillation triggers in patients undergoing repeat pulmonary vein isolation: implications for ablation strategies. J Cardiovasc Electrophysiol. 2003;14(7):685–90.

    Article  Google Scholar 

  7. Ouyang F, Antz M, Ernst S, et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: lessons from double Lasso technique. Circulation. 2005;111(2):127–35.

    Article  Google Scholar 

  8. Hitoshi M, Ritsushi K, Naokata S, et al. Relations between the ablation index, lesion formation, and incidence of steam pops. J Arrythm. 2019;35:636–44.

    Google Scholar 

  9. Das M, Loveday JJ, Wynn GJ, et al. Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. Europace. 2017;19:775–83.

    PubMed  Google Scholar 

  10. Nakagawa H, Ikeda A, Govari A, et al. Prospective study using a new formula incorporating contact force, radiofrequency power and application time (force-power-time index) for quantifying lesion formation to guide long continuous atrial lesions in the beating canine heart. Circulation. 2018;128:A12104(abstr).

    Google Scholar 

  11. Solimene F, Schillaci V, Shopova G, et al. Safety and efficacy of atrial fibrillation ablation guided by ablation index module. J Interv Card Electrophysiol. 2019;54:9–15.

    Article  Google Scholar 

  12. Okamatsu H, Okumura K, Kaneko S, et al. Ablation index-guided high-power radiofrequency application shortens the procedure time with similar outcomes to conventional power application in atrial fibrillation ablation. Circ Rep. 2021;3:559–68.

    Article  Google Scholar 

  13. Paula M, Stefan K, Spyridon L, et al. Ablation index for catheter ablation of atrial fibrillation -clinical applicability and comparison with force-time integral. Circ J. 2018;82:2722–7.

    Article  Google Scholar 

  14. Lee So-Ryoung, Choi Eue-Keun, Lee Eui-Jae, et al. Efficacy of the optimal ablation index–targeted strategy for pulmonary vein isolation in patients with atrial fibrillation: the OPTIMUM study results. J Interv Card Electrophysiol. 2019;55:171–81.

    Article  Google Scholar 

  15. Zhang T, Wang Y, Han Z, et al. Cavotricuspid isthmus ablation using ablation index in typical atrial flutter. J cardiovasc electrophysiol. 2019;30:2414–9.

    Article  Google Scholar 

  16. Miyazaki S, Taniguchi H, Kusa S, et al. Conduction recovery after electrical isolation of superior vena cava – prevalence and electrophysiological properties. Circ J. 2013;77:352–8.

    Article  Google Scholar 

  17. Sanchez-Quintana D, Cabrera JA, Climent V, et al. Anatomic relations between the esophagus and left atrium and relevance for ablation of atrial fibrillation. Circulation. 2005;112:1400–5.

    Article  Google Scholar 

  18. Joseph BM, Prashanthan S, Neil CD, et al. Phased-array intracardiac echocardiography for defining cavotricuspid isthmus anatomy during radiofrequency ablation of typical atrial flutter. J Cardiovasc Electrophysiol. 2003;14:591–7.

    Article  Google Scholar 

  19. Kholova I, Kautzner J. Morphology of atrial myocardial extensions into human caval veins. Circulation. 2004;110:483–8.

    Article  Google Scholar 

  20. Nagashima K, Watanabe I, Okumura Y, et al. High-voltage zones within the pulmonary vein antra: Major determinants of acute pulmonary vein reconnections after atrial fibrillation ablation. J Interv Card Electrophysiol. 2017;49:137–45.

    Article  Google Scholar 

  21. Suraj K, Benoit D, David JC, et al. Contact electroanatomic map** derived voltage criteria for characterizing left atrial scar in patients undergoing ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25:1044–52.

    Article  Google Scholar 

  22. Winkle RA, Moskovitz R, Hardwin Mead R, et al. Atrial fibrillation ablation using very short duration 50W ablations and contact force sensing catheters. J Interv Card Electrophysiol. 2018;52(1):1–8.

    Article  Google Scholar 

  23. Chen S, Schmidt B, Bordignon S, et al. Ablation Index-guided 50W ablation for pulmonary vein isolation in patients with atrial fibrillation: procedural data, lesion analysis, and initial results from the FAFA AI high power study. J Cardiovasc Electrophysiol. 2019;30(12):2724–31.

    Article  Google Scholar 

  24. Eran L, Cory MT, Michael B, et al. High-power and short-duration ablation for pulmonary vein isolation. ~Biophysical Characterization~. JACC: Clin Electrophysiol 2018;4(4):467–479.

  25. Michael B, Fernando MC, Eran L, et al. High-power and short-duration ablation for pulmonary vein isolation: Safety, efficacy, and long-term durability. J Cardiovasc Electrophysiol. 2018;29:1287–96.

    Article  Google Scholar 

  26. Shinsuke M, Kazuya Y, Kanae H, et al. SVC map** using an ultra-high resolution 3-dimensional map** system in patients with and without AF. JACC: Clin Electrophysiol 2019;5:958–967.

Download references

Acknowledgements

We appreciate the help in proofreading our manuscript by Mr. John Martin.

Author information

Authors and Affiliations

  1. Department of Cardiology, Japan Self Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo, Japan

    Daisuke Kawano, Hitoshi Mori, Mitsuki Yamaga, Akane Kawai, Atsushi Sato, Midori Yukino, Youdou Gatate, Akira Hamabe & Hirotsugu Tabata

  2. Department of Cardiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan

    Daisuke Kawano, Hitoshi Mori, Kenta Tsutsui, Yoshifumi Ikeda, Ritsushi Kato & Kazuo Matsumoto

Authors
  1. Daisuke Kawano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hitoshi Mori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenta Tsutsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshifumi Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mitsuki Yamaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akane Kawai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Atsushi Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Midori Yukino
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Youdou Gatate
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Akira Hamabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hirotsugu Tabata
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ritsushi Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kazuo Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HM and DK: study conception and design. MY, AK, MY, YG, and AS: data collection and data analysis. AH, KT, and IY: manuscript revision. HT and RK: study supervision.

Corresponding author

Correspondence to Hitoshi Mori.

Ethics declarations

Ethics approval

The study was approved by the institutional review board.

Consent to participate/publication

All patients provided their informed consent to the procedure and publication.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kawano, D., Mori, H., Tsutsui, K. et al. The target ablation index values for electrical isolation of the superior vena cava. J Interv Card Electrophysiol 64, 687–694 (2022). https://doi.org/10.1007/s10840-021-01112-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-021-01112-w

Keywords

Search

Navigation