Characterizing Clinical Outcomes and Factors Associated with Conduction
Gaps in VISITAG SURPOINT-Guided Catheter Ablation for Atrial
Fibrillation
Abstract
Background: Few studies have explored the link between VISITAG SURPOINT
(VS) parameters and the inter-tag distance (ITD) on pulmonary vein
isolation (PVI) in catheter ablation of atrial fibrillation (AF).
Objective: To examine the clinical outcomes and factors contributing to
residual conduction and reconnection gaps during PVI. Methods and
Results: A retrospective review of consecutive patients (N=100) with
paroxysmal (n=32) or persistent AF (n=68) undergoing VS-guided ablation
between 09/2018-08/2019 was performed. All procedures were performed by
2 operators. Target VS values were 425 (anterior), 375 (posterior), and
325 (in proximity of the esophagus). Target ITD was 4 mm. Acute PVI was
achieved in 100% of cases, however 13 residual gaps in 12 patients were
observed after the first encirclement (first pass isolation: 88%). Ten
gaps due to spontaneous PV reconnections (PVR) were found in 9 patients
(9%). Tags associated with these 23 gaps had similar median VS
(gap-related vs. non-gap: 429 vs. 410, p=0.4545) and power (36 vs. 36W,
p=0.4843), higher contact force (13.8 vs. 11.0g, p=0.0061), and larger
ITD (5.3 vs. 3.7mm, p<0.001) when compared to the remaining
tags. At median follow-up of 462 days (N=99 patients), freedom from any
atrial arrhythmia was 84.8%. Eight patients received repeat ablation
(8.1%) and of these, 6 (75%) were free from PVR. No major adverse
events were noted. Conclusion: Favorable rates of first pass isolation,
acute PVR, and long-term procedure success were achieved using lower VS
values than in previous reports. Under these settings, larger ITDs are
associated with residual conduction and reconnections.