The optimal Ablation Index Values for Electrical Isolation of the
Superior Vena Cava
Abstract
Background The ablation index (AI) has been reported to be useful for a
durable pulmonary vein isolation (PVI) to treat atrial fibrillation
(AF). No study has reported the optimal AI value for the SVC isolation
(SVCI). In this study, we aimed to investigate the optimal AI for the
SVCI. Methods Thirty-six AF patients who underwent an initial SVCI were
enrolled. Ablation was performed at a total of 549 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, CF, Force-Time Integral (FTI), and AI between the touch up
sites and control sites (n=513). Results The median RF delivery time,
power, CF, and FTI were all significantly lower at the touch up sites
(touch up sites vs. control sites; energy delivery time, sec,
20.3[12.3-21.7] vs. 21.6[19.8-25.2], p=0.0003; power, W,
23.5[15-24] vs. 24[20-25], p<0.0001; CF, g,
7[6-10.8] vs. 11[9-15], p<0.0001; FTI,
126.5[99.3-208.8] vs. 244[183.5-340.5], p<0.0001). The
AI also was significantly lower at the Touch up sites (touch up sites
vs. control sites; AI, 350.1±43.6 vs. 277.2±21.8, p<0.0001).
The median value of the AI at the control sites was 350 and no
reconnections were seen where the minimum AI value was more than 308.
Conclusion The AI value at the touch up sites was significantly lower
than that at the control sites. The optimal AI value for the SVCI should
be 350, and at least 308 would be needed.