{"id":"6883b936521e","type":"article","url":"https://hartvaat.nl/2020/10/01/optimale-interlaesieafstand-bij-ablatie-index-geleide-af-ablatie-gerandomiseerde/","title":"Optimale interlaesieafstand bij ablatie-index-geleide AF-ablatie: gerandomiseerde studie","title_en":"Randomized study defining the optimum target interlesion distance in ablation index-guided atrial fibrillation ablation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaa147","source_url":"https://doi.org/10.1093/europace/euaa147","authors":["Philipp Hoffmann","Ivan Diaz Ramirez","Gerd Baldenhofer","Karl Stangl","Lluís Mont","Till F Althoff"],"significance":5,"published":"2020-10-01","source_date":"2020-10-01","image":"","kennis":[],"congress":"","summary_en":"This randomized study determined the optimal interlesion distance in ablation index-guided AF ablation, defining the spacing parameters that achieve durable pulmonary vein isolation with the CLOSE protocol.","created":"2026-07-03T10:28:48Z","updated":"2026-07-03T13:27:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde studie naar de optimale afstand tussen ablatielaesies bij ablatie-index-geleide AF-ablatie.","abstract_original":"AIMS: While the CLOSE protocol proposes a maximally tolerable interlesion distance (ILD) of 6 mm for ablation index ablation index-guided atrial fibrillation (AF) ablation, a target ILD has never been defined. This randomized study sought to establish a target ILD for ablation index-guided AF ablation. METHODS AND RESULTS: Consecutive patients scheduled for first-time pulmonary vein (PV) isolation (PVI) were randomly assigned to ablation protocols with a target ILD of 5.0-6.0 mm or 3.0-4.0 mm, with the primary endpoint of first-pass PVI. In compliance with the CLOSE protocol, the maximum tolerated ILD was 6.0 mm in both study protocols. A target ablation index of ≥550 (anterior) or ≥400 (posterior) was defined for the '5-6 mm' protocol and ≥500 (anterior) or ≥350 (posterior) for the '3-4 mm' protocol. The study was terminated early for superiority of the '3-4 mm' protocol. Forty-two consecutive patients were randomized and 84 ipsilateral PV pairs encircled according to the study protocol. First-pass PVI was accomplished in 35.0% of the '5-6 mm' group and 90.9% of the '3-4 mm' group (P < 0.0001). Median ILD was 5.2 mm in the '5-6 mm' group and 3.6 mm in the '3-4 mm' group (P < 0.0001). In line with the distinct ablation index targets, median ablation index was lower in the '3-4 mm' group (416 vs. 452, P < 0.0001). While mean procedure time was shorter in the '3-4 mm' group (149 ± 27 vs. 167 ± 33min, P = 0.004), fluoroscopy times did not differ significantly (4.7 ± 2.2 vs. 5.1 ± 1.8 min, P = 0.565). CONCLUSION: In ablation index-guided AF ablation, an ILD of 3.0-4.0 mm should be targeted rather than 5.0-6.0 mm. Moreover, the lower target ILD may allow for less extensive ablation at each given point."}