Favorable Effects of AI on ERATs
In this study, we revealed that AI-guided PVI could reduce ERATs more
than CF-guided PVI. Tokuda et al. reported that the incidence of ERAT
after PVI for PAF was similar between Cryoballoon ablation and
conventional radiofrequency CA (21% vs. 27%,
p=0.15).11 We considered that AI-guided PVI was the
most effective modality for reducing ERATs in PAF patients (15.2%).
Preclinical studies in an animal model have demonstrated that AI
accurately predicts the depth of ablation lesions.9AI-guided PVI can produce a higher impedance drop, and AI plays a role
as a parameter of the effectiveness of a lesion
formation.12 Several reports have demonstrated that
AI-guided PVI could achieve a durable PVI and reduce late PV
reconnections,13 which is consistent with our results.
We considered that AI could reduce late PV reconnections, which could
lead to reduction in ERATs.
In our study, AI-guided PVI decreased late PV reconnections, especially
RSPV. Septopulmonary bundle runs through the RSPV ostium, which is
relatively thick LA muscular bundle and renders RSPV isolation
difficult.14 We suggested that AI-guided ablation
could form transmural ablation lesion at this site, that lead to less
reconnection of RSPV. Furthermore, the localization of focal AF triggers
occurs frequently in RSPV.15 On the other hand, the
rate of left PV reconnections was similar between AI group and CF group,
which could be explained by the fact that we attenuated the
radiofrequency delivery to the LPV posterior wall to prevent esophageal
injury in both 2 groups.