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19/Reduction in healthcare utilization associated with the use of ablation index guided pulmonary vein isolation

Published Online: September 27th 2010 European Journal of Arrhythmia & Electrophysiology. 2020;6(Suppl. 1):abstr19
Authors: DG Gupta (Presenting Author) - Liverpool Heart and Chest Hospital, Liverpool; TH Hunter - Clinical Trial & Consulting, Covington; JV Vijgen - Virga Jessa Ziekenhuis, Hasselt; TD De Potter - Onze Lieve Vrouwziekenhuis Ziekenhuis Aalst-Asse-Ninove, Aalst; DS Scherr - Medical University Graz, Graz; HV Van Herendael - Ziekenhuis Oost – Limburg Campus, Genk; SK Knecht - AZ St Jan Brugge, Brugge; RK Kobza - Luzerner Kantonsspital Herzzentrum, Luzern; BB Berte - Luzerner Kantonsspital Herzzentrum, Luzern; NS Sandgaard - Odense University Hospital, Odense; JA Albenque - Clinique Pasteur, Toulouse; GS Szeplaki - Mater Private Hospital, Dublin; YJS Stevenhagen - Thoraxcentrum, Enschede; PT Taghji - Clinical Clairval Marseille, Marseille; MW Wright - St. Thomas Hospital London, London; MD Duytschaever - AZ St Jan Brugge, Brugge
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Background: Prior studies have shown that a standardized pulmonary vein isolation (PVI) workflow guided by a single ablation index (AI) value and a maximum interlesion distance (ILD) between corresponding ablation tags is associated with high single-procedure 1-year clinical success. Improvement in 1-year success may translate to lower cardiovascular healthcare utilization.

Purpose: To evaluate the effect of a standardized AI workflow in PAF ablation on cardiovascular healthcare utilization.

Methods: Patients were ablated for PAF in a prospective non-randomized clinical study across 17 European centres. Ablations followed a standard AI workflow (AI targets: 400 posterior, 550 anterior, ILD ≤6 mm) utilizing a contact force catheter, location stability settings of 2-3 mm for 3-5 s, 3 g force, and 25% force over time. Cardioversions and overnight cardiovascular hospitalizations were recorded for the 12-month periods pre- and post-ablation.

Results: A total of 329 patients were eligible and ablated with AI guidance (age 61 ± 10 years, 60.8% male, CHA2DS2-VASc 1.6 ± 1.4). Cardiovascular hospitalizations were reduced by 42% (99 to 57, p=0.0015) and cardioversions were reduced by 62% (77 to 29, p<0.0001) after ablation (Figure). The 57 post-ablation cardiovascular hospitalizations included 35 repeat ablations in 33 subjects (10%).

Conclusion: A standardized workflow incorporating AI guidance with a maximum ILD for PAF ablation resulted in a substantial reduction in cardiovascular hospitalization in the 12 months following ablation compared to the 12 months prior.

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