The industrialization of ablation: a highly standardized and reproducible workflow for radiofrequency ablation of atrial fibrillation

摘要

Background or Purpose The purpose of this analysis was to report on efficacy of a standardized workflow for atrial fibrillation (AF) ablation using technology advances such as 3D imaging and contact force sensing in a real-world setting. Methods Consecutive AF ablations from 2014 to 2015 at a high-volume site in Belgium were included. The workflow consisted of a pre-specified procedure sequence including 3D modeling followed by radiofrequency encircling of the pulmonary veins (25 W posterior wall, 35 W anterior wall) with a THERMOCOOL SMARTTOUCH (R) Catheter guided by CARTO VISITAG (TM) Module (2.5 mm/5 s stability, 50% > 7 g) and ablation index (targets: 550 anterior wall, 400 posterior wall). Efficiency endpoints were procedure time, fluoroscopy time, and radiation dose. The primary effectiveness endpoint was freedom from atrial arrhythmia recurrence. Results A total of 605 paroxysmal AF (PAF) and 182 persistent AF (PsAF) patients were followed for 436 +/- 199 days. Mean procedure times were short (PAF: 96.1 +/- 26.2 min; PsAF: 109.2 +/- 35.6 min) with most procedures (90.6% PAF; 81.3% PsAF) completed in <= 120 min. Minimal fluoroscopy was utilized (PAF: 6.1 +/- 3.8 min, 5.9 +/- 3.4 Gy*cm(2); PsAF: 6.9 +/- 4.7 min, 7.4 +/- 4.9 Gy*cm(2)). Freedom from atrial arrhythmia recurrence was higher for PAF than PsAF patients (OR: 2.0, 95% CI: 1.4-2.9, p = 0.0003), but adjusted mean rates were high in both groups (81.0% vs. 67.9%). Rates were adjusted for prior ablation and age (at 65 years). Conclusion AF ablation using a standardized workflow resulted in low procedure times and variability, with minimal fluoroscopy exposure. Long-term freedom from atrial arrhythmia recurrence was high in both PAF and PsAF populations.