SJTU Affiliated People’s First Hospital Announced “Shanghai Standard” of Atrial Fibrillation Ablation

Atrial fibrillation is known to havea high mortality and morbidity, and catheter radiofrequency ablation is the first choice for the treatment of paroxysmal atrial fibrillation, whose surgical effectsare closely related to the degree of ablation. However, the lack of quantized standards for the degree of ablation makes big differencesbetwwensurgical effect. Recently, Cardiology Department of Shanghai First People‘s Hospital affiliated to SJTU has completed 4 cases catheter ablation with the latest catheter radiofrequency ablation auxiliary tool “ablation index system”, and according to statistics of big data analysis, has firstly released the “ablation index” target value applied to Chinese people establishing a “Shanghai Standard”, which makes it easier to observe and assess the radiofrequency ablation of atrial fibrillation.

On March 6, an atrial fibrillation catheter radiofrequency ablation surgery was undergoing in the heart catheter theater of Shanghai First People’s Hospital, with an extra display in front of the patient than usual, which did not only show three-dimensional image ofthe heart, but also marked the data indicating ablation duration, temperature, pressure. The data had been changing all the time and finally aggregated into an index, when which came to 464, it indicated that it was deep enough for the performer to stop the ablation.

This is the newly global used “ablation index system” for catheter radiofrequency ablation of atrial fibrillation, which can integrate multiple parameters such intraoperative stability of the tube, the radiofrequency energy, stress and ablation duration, and calculated a real-time index indicating the degree of ablation, namely “ablationindex”. Performers will stop the ablation when the index reaches the preset target value which varies in different positions of the atrium.

According to Professor Liu Shaowen, the director of the Cardiology Department of First People‘s Hospital of Shanghai, in catheter radiofrequency ablations, surgical effect depends on the stick pressure between the catheter and the atrial wall, ablations energy, length of ablation energy and some other factors. A poorly thorough ablation contributes to a high recurrence, while excessive ablation causesserious complications such as cardiac tamponade and atrial-esophageal fistula. He added, the previous surgeons were conducted on a rough estimate of ablation based on history data and personal experience, resulting in different surgical results. Now, the performance of ablation can be shown by numbers on the “Ablation index system” which can stops the ablation once it achieves the default value, and finally to great extent, increases the efficiency, shortens the time and ensures the effectiveness and safety of the surgery and realize accuracy of Catheter Radiofrequency ablation. Catheter radiofrequency ablation of atrial fibrillation is now going to embrace the era of big data.

In fact, “ablation index system” has been studied for half a year by the Cardiology Department of Shanghai First People’s Hospital. “A national ablative index standard should be set to bring the system into practice.” Professor Liu said, “Since September in 2016, we have collected and analyzed over 200 cases of atrial fibrillation ablation surgery and tens of millions of clinical data, and finally summarized the reasonable ablation index target values after modified and optimized for many times.” It also means that after this system is promoted, all the Chinese atrial fibrillation radiofrequency ablations will follow the “Shanghai standard”. Besides, the index also can be used as a unified language which makes it convenient to communicate and learn, then presents the common experience in the field of catheter ablation and unique skills of each doctor, and at last, greatly reduces the difficulty in developing physicians specialized in catheter ablation, which is expected to make the heart intervention technology to benefit more patients with atrial fibrillation.

It is known that there are 80,000 to 10,000,000 patients with atrial fibrillation in China, and the total number of patients is increasing as the population ages. Compared with normal population, atrial fibrillation has a high mortality and morbidity, and the complication of thromboembolic is the main cause of disability and death. Because of the limited therapeutic effect, radiofrequency catheter ablation has become the first choice for paroxysmal atrial fibrillation.