{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:02:40Z","timestamp":1779105760097,"version":"3.51.4"},"reference-count":14,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The formation of transmural lesions is necessary for the ablation of persistent atrial fibrillation (prAF). Ablation index (AI) and generator impedance drop (ID) predict lesion size but their correlation with long\u2010term outcomes in prAF is not known. Furthermore, we proposed a new parameter, efficacy ratio (ER) calculated as ID\/AI, to gain indirect insight into the role of factors affecting ID but not considered by AI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included ablations performed during the DECAAF II trial if they had uploaded lesion\u2010by\u2010lesion summary data and were performed with radiofrequency catheters on the CARTO system. Average patient\u2010level parameters were calculated from all generated Vizitags.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 427 ablations met inclusion criteria and 166 utilized AI. Analyzed as continuous variables, ID and ER predicted long\u2010term arrhythmia\u2010free survival but not AI. The ideal cut\u2010off for ID was ID\u2009\u2265\u200910.4 ohms and had a C\u2010index of 0.55. It predicted reduced risk of arrhythmia: hazard ratio 0.56 [0.36\u20130.88], <jats:italic>p<\/jats:italic>\u2009=\u2009.013 (arrhythmia\u2010free survival of 67% vs. 52%). Similarly, an ER of 1.7\u2009ohms\/100AI had a C\u2010index of 0.58 and predicted reduced arrhythmia recurrence: HR\u00a00.39 [0.22\u20130.69], <jats:italic>p<\/jats:italic>\u2009=\u2009.001. ER\u2009&lt;\u20091.7\u2009ohms\/100AI was related to just 32% arrhythmia\u2010free survival. ER improved prognostication as compared to ID alone and identified a subset of low ID patients with even worse outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Average ID was predictive of improved outcomes following ablation of prAF. The ratio of ID\/AI (ER) was postulated as a measure to summarize the overall impact of factors not considered in the AI formula and provided improved prognostication.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16438","type":"journal-article","created":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T06:10:14Z","timestamp":1728972614000},"page":"2414-2422","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Lesion monitoring parameters as predictors of atrial arrhythmia recurrence after catheter ablation in persistent AF: A DECAAF II sub\u2010analysis"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8809-5419","authenticated-orcid":false,"given":"Mario","family":"Mekhael","sequence":"first","affiliation":[{"name":"Department of Cardiology\u2014Cardiac Electrophysiology, Tulane Research and Innovation for Arrhythmia Discoveries\u2014TRIAD Center Tulane University School of Medicine New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3163-8931","authenticated-orcid":false,"given":"Han","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Cardiology\u2014Cardiac Electrophysiology, Tulane Research and Innovation for Arrhythmia Discoveries\u2014TRIAD Center Tulane University School of Medicine New Orleans Louisiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7202-1164","authenticated-orcid":false,"given":"Hadi","family":"Younes","sequence":"additional","affiliation":[{"name":"Department of Cardiology\u2014Cardiac Electrophysiology, Tulane Research and Innovation for Arrhythmia Discoveries\u2014TRIAD Center Tulane University School of Medicine New Orleans Louisiana 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