Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation

Boga, Márton; Orbán, Gábor; Perge, Péter; Salló, Zoltán; Tanai, Edit; Ferencz, Arnold Béla; Tóth, Patrik; Komlósi, Ferenc; Osztheimer, István; Nagy, Klaudia Vivien; Merkely, Béla; Gellér, László; Szegedi, Nándor

doi:10.3390/jcm13071960

Open AccessArticle

Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation

by

Márton Boga

,

Gábor Orbán

,

Péter Perge

,

Zoltán Salló

,

Edit Tanai

,

Arnold Béla Ferencz

,

Patrik Tóth

,

Ferenc Komlósi

,

István Osztheimer

,

Klaudia Vivien Nagy

,

Béla Merkely

,

László Gellér

and

Nándor Szegedi

^*

Heart and Vascular Center, Semmelweis University, 1085 Budapest, Hungary

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2024, 13(7), 1960; https://doi.org/10.3390/jcm13071960

Submission received: 2 March 2024 / Revised: 24 March 2024 / Accepted: 26 March 2024 / Published: 28 March 2024

(This article belongs to the Special Issue Cardiac Electrophysiology: New Insights and Future Directions)

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Abstract

Background: Atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) is predominantly attributed to pulmonary vein reconnection (PVR). Predictors of AF recurrence have been widely studied; however, data are scarce on procedural parameters that predict chronic PVR. We aimed to study PVR rates and predictors of PVR. Methods: We retrospectively included 100 patients who underwent repeated ablation due to AF recurrence after initial PVI with the CARTO system. PVR was determined during the repeated procedure by electrophysiological evaluation, and initial procedural characteristics predicting PVR were studied, including adherence to the CLOSE protocol, use of high power, first-pass isolation (FPI), and baseline generator impedance (BGI). Results: Thirty-eight patients underwent initial CLOSE-guided PVI, and sixty-two underwent initial non-CLOSE PVI. A repeat procedure was performed 23 ± 16 months after the initial procedure. In total, PVR was found in 192 of 373 PVs (51.5%), and all PVs were isolated in 17/100 (17%) patients. Factors associated with all PVs being isolated were adherence to the CLOSE protocol, a higher power setting, the presence of bilateral FPI, and lower BGI (88% vs. 28%, p < 0.0001; 37.5 W vs. 30 W, p = 0.0276; 88.2% vs. 40.4%, p = 0.0007; and 127.6 Ω vs. 136.6 Ω, p = 0.0027, respectively). In initial procedures with adherence to the CLOSE protocol, the FPI rate was significantly higher (73.7% vs. 25%, p < 0.0001), while there were no significant differences in terms of procedure time and left atrial dwell time (81 vs. 85 min, p = 0.83; and 60 vs. 58 min, p = 0.08, respectively). BGI ≥ 130 Ω (AUC = 0.7403, sensitivity: 77.1%, specificity: 68.8%, p = 0.0032) was associated with a significantly higher probability of PVR (OR = 6.757; p < 0.0001). In multivariable analysis, independent predictors for PVR were non-adherence to the CLOSE protocol and BGI ≥ 130 Ω. Conclusions: Our findings indicate that adherence to the CLOSE protocol and baseline generator impedance < 130 Ω during AF ablation are independent predictors of PVI durability.

Keywords: pulmonary vein isolation; pulmonary vein reconnection; CLOSE protocol; generator impedance

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MDPI and ACS Style

Boga, M.; Orbán, G.; Perge, P.; Salló, Z.; Tanai, E.; Ferencz, A.B.; Tóth, P.; Komlósi, F.; Osztheimer, I.; Nagy, K.V.; et al. Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation. J. Clin. Med. 2024, 13, 1960. https://doi.org/10.3390/jcm13071960

AMA Style

Boga M, Orbán G, Perge P, Salló Z, Tanai E, Ferencz AB, Tóth P, Komlósi F, Osztheimer I, Nagy KV, et al. Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation. Journal of Clinical Medicine. 2024; 13(7):1960. https://doi.org/10.3390/jcm13071960

Chicago/Turabian Style

Boga, Márton, Gábor Orbán, Péter Perge, Zoltán Salló, Edit Tanai, Arnold Béla Ferencz, Patrik Tóth, Ferenc Komlósi, István Osztheimer, Klaudia Vivien Nagy, and et al. 2024. "Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation" Journal of Clinical Medicine 13, no. 7: 1960. https://doi.org/10.3390/jcm13071960

APA Style

Boga, M., Orbán, G., Perge, P., Salló, Z., Tanai, E., Ferencz, A. B., Tóth, P., Komlósi, F., Osztheimer, I., Nagy, K. V., Merkely, B., Gellér, L., & Szegedi, N. (2024). Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation. Journal of Clinical Medicine, 13(7), 1960. https://doi.org/10.3390/jcm13071960

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Adherence to the CLOSE Protocol and Low Baseline Generator Impedance Are Independent Predictors of Durable Pulmonary Vein Isolation

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