AI-based index-tagging module improves ablation performance in paroxysmal AF
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An artificial intelligence-based module to help achieve more effective pulmonary vein isolation in patients undergoing catheter ablation for paroxysmal atrial fibrillation was associated with high rates of success, researchers reported.
The module (Visitag Surpoint, Biosense Webster), used with a radiofrequency catheter (Thermocool SmartTouch, Biosense Webster), uses an index that includes contact force, power and time to create a surrogate marker of ablation lesion quality, which could optimize pulmonary vein isolation, the researchers wrote in JACC: Clinical Electrophysiology.
Artificial intelligence algorithm
“When performing catheter ablation, one of the main reasons for the failure of the procedure is the inability of the operator to achieve transmural lesion,” Luigi Di Biase, MD, PhD, FACC, FHRS, section head of electrophysiology and director of arrhythmia services at Montefiore-Einstein Center for Heart & Vascular Care, and professor of medicine (cardiology) at Albert Einstein College of Medicine, told Healio. “There is not a direct way to understand this. So with point-by-point radiofrequency ablation, we look at several indirect parameters. With this approach, we are putting together contact force, power and surrogates of tissue temperature. The Surpoint puts together an artificial intelligence algorithm with as much information as possible — the power, the force and the time you are in contact with the tissue — and comes out with a number that you need to achieve in order for that lesion to be as predictably transmural as possible. If you don’t achieve this number, you can’t move to the next lesion.”
For the SURPOINT prospective, nonrandomized postapproval study, Di Biase and colleagues performed radiofrequency catheter ablation guided by the module on 261 patients with drug-refractory paroxysmal AF (mean age, 64 years; 58% men).
Mean fluoroscopy time was 2.2 minutes, according to the researchers.
The primary safety endpoint of primary adverse events at 7 days occurred in 4.3% of the cohort (14 events in 11 patients), and the posterior mean of the primary adverse event rate was 4.7% (95% Bayesian credible interval, 2.4-7.6), beating the performance goal of 14%, the researchers wrote.
The primary effectiveness endpoint, evaluated in 246 patients who underwent the procedure and met all eligibility criteria, was freedom from atrial tachyarrhythmia recurrence and an additional set of failure modes based on stringent monitoring at 1 year.
At 1 year, the Kaplan-Meier estimate of freedom from failure to achieve the primary effectiveness endpoint was 76.4%, whereas the estimates of freedom from AF, atrial tachycardia or atrial flutter recurrence were 81.5% by stringent monitoring and 92.7% by standard-of-care monitoring, the researchers wrote.
‘A very high level of outcomes’
“With the support of this technology, we can achieve a very high level of outcomes with a reasonable number of complications,” Di Biase told Healio.
The rate of first-pass isolation, defined as no acute reconnection after a 30-minute waiting period, was 83.1%, and the rate of freedom from repeat ablation at 1 year was 94%, according to the researchers.
Pulsed field ablation is less likely to damage surrounding tissues than radiofrequency or cryoballoon ablation because it is not thermal in nature, but it is still in development, and using the algorithm with current technology “can achieve a very high rate of success that will be very hard for a new energy source to beat,” Di Biase told Healio.
In a related editorial, Riccardo Cappato, MD, and Hussam Ali, MD, both from the Arrhythmia and Electrophysiology Center, IRCCS MultiMedica, Milan, wrote, “The high efficacy and safety outcomes shown in the present study confirm those obtained in previous studies from different geographical areas and reassure about the exportability of results on a global scale.”
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For more information:
Luigi Di Biase, MD, PhD, FACC, FHRS, can be reached at dibbia@gmail.com; Twitter: @luigidibiasemd.
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