Quantitative analysis of ablation technique predicts arrhythmia recurrence following atrial fibrillation ablation

Background Optimal ablation technique, including catheter-tissue contact during atrial fibrillation (AF) radiofrequency (RF) ablation, is associated with improved procedural outcomes. We used a custom developed software to analyze high-frequency catheter position data to study the interaction between catheter excursion during lesion placement, lesion-set sequentiality, and arrhythmia recurrence. Methods A total of 100 consecutive patients undergoing first-time RF ablation for paroxysmal AF were analyzed. Spatial positioning of the ablation catheter sampled at 60 Hz during RF application was extracted from the CARTO3 system (Biosense Webster Inc, USA) and analyzed using custom-developed MATLAB software to determine precise catheter spatial 3D excursion during RF ablation. The primary end point was freedom from atrial arrhythmia lasting longer than 30 seconds after a single ablation procedure. Results At 1 year, 86% of patients were free from recurrent arrhythmia. There was no significant difference in clinical, echocardiographic, or ablation characteristics between patients with and without recurrent arrhythmia. Analyzing 15,356,998 position data points revealed that lesion-set sequentiality and mean lesion catheter excursion were predictors of arrhythmia recurrence. Analyzing arrhythmia recurrence by mean single-lesion catheter excursion (excursion >2.81 mm) and by sequentiality (using 46% of lesions with interlesion distance >6 mm as cutoff) revealed significantly increased arrhythmia recurrence in the higher excursion group (23% vs 6%, P = .03) and in the less sequential group (24% vs 4%, P = .02). Conclusions Ablation lesion sequentiality measured by catheter interlesion distance and catheter stability measured by catheter excursion during lesion placement are potentially modifiable factors affecting arrhythmia recurrence after RF ablation for AF.