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Bates AP, Paisey J, Yue A, Banks P, Roberts PR, Ullah W. Determinants of left atrial local impedance: Relationships with contact force, atrial fibrosis, and rhythm. J Cardiovasc Electrophysiol 2024; 35:1061-1068. [PMID: 38501564 DOI: 10.1111/jce.16253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 11/15/2023] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The relationships between baseline tissue local impedance (LI), contact force (CF), atrial fibrosis, and atrial rhythm are uninvestigated in a clinical setting. We compared the relationship of LI and CF between atrial fibrillation (AF) and sinus rhythm (SR) accounting for the effects of atrial fibrosis as assessed by bipolar voltage and LI. METHODS Patients undergoing persistent AF ablation were recruited. LI was recorded referenced to patient blood pool (LIr) and concurrent to changes in CF, with data collected at the same locations in AF and SR. RESULTS Twenty patients were recruited. 109 locations were sampled obtaining 1903 data points (SR: 966, AF: 937). CF correlated strongly with LI (repeated measures correlation = 0.64). The relationship between CF and LIr was logarithmic. Rhythm and CF had a significant main (both p < .0005) and interaction effect (p = .022) on tissue LI: AF demonstrated higher LIr values than SR for similar CF. Bipolar voltage had no effect on the relationship of CF to LIr in either rhythm. Assessing fibrosis using LIr showed an interaction effect with CF for LIr in SR and AF, (SR: p < .0005, AF: p = .01), with increased fibrosis showing lesser change in LIr per gram of CF. CONCLUSIONS CF and rhythm significantly affect the measured LIr of LA myocardium. Optimal catheter-tissue coupling may be better achieved with higher levels of CF and in AF rather than SR. Atrial fibrosis, as assessed by LIr but not bipolar voltage, affected the CF-LI relationship.
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Affiliation(s)
- Alexander P Bates
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - John Paisey
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Arthur Yue
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Phil Banks
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Paul R Roberts
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Waqas Ullah
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
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Ogiso S, Fukaya H, Ogawa E, Mori H, Masuda Y, Yazaki Y, Murayama Y, Saito D, Kobayashi S, Nakamura H, Ishizue N, Kishihara J, Niwano S, Oikawa J, Ako J. "Honey Pot"-Like Lesion Formation: Impact of Catheter Contact Angle on Lesion Formation by Novel Diamond-embedded Temperature-controlled Ablation Catheter in a Porcine Experimental Model. Heart Rhythm 2024:S1547-5271(24)02569-4. [PMID: 38759918 DOI: 10.1016/j.hrthm.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Novel diamond-embedded catheter enables precise temperature-controlled ablation. However, the effects of contact angle on lesion formation of this catheter are poorly understood. OBJECTIVE This study evaluated lesion formation using the temperature-controlled ablation catheter embedded with diamond at different angles in a porcine experimental model. METHODS We used freshly sacrificed porcine hearts, and radiofrequency catheter ablation was performed at 50 watts for 15 s at an upper-temperature setting of 60°C. The contact force (5, 10, and 30 g) and catheter contact angles (30°, 45°, and 90°) were changed in each set (n = 13 each). The surface width, maximum lesion width, lesion depth, surface area, distance from the distal edge to the widest area, and impedance drop were evaluated. RESULTS The surface width and maximum lesion width were longer at 30° than at 90° (p<0.05). There were no significant differences in the lesion depth by catheter angle except at 30 g. The surface area was larger at 30° than at 90° (p<0.05). The distance from the distal edge to the widest area was longer at 30° than at 90° (p<0.05). There were no significant differences in the impedance drop according to the catheter angle. CONCLUSION With the diamond-embedded temperature-controlled ablation catheters, the lesion width increased at a shallower contact angle, whereas the lesion depth did not. The surface area also increased at a shallower contact angle. This catheter created a large ablation lesion on the proximal side of the catheter, which looked like a "Honey pot."
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Affiliation(s)
- Sho Ogiso
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan.
| | - Emiyu Ogawa
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Hitoshi Mori
- Department of Cardiology, Saitama Medical University, International Medical Center, Hidaka, Saitama, Japan
| | - Yuya Masuda
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Yuto Yazaki
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Yusuke Murayama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Daiki Saito
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shuhei Kobayashi
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hironori Nakamura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Jun Oikawa
- Department of Kitasato Clinical Research Center, Kitasato University School of Medicine, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
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Chen WT, Chung FP, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Kuo L, Wu CI, Liu CM, Liu SH, Hsieh YC, Li CH, Chen SA. Lower contact force predicts right pulmonary vein carina breakthrough after ablation index-guided pulmonary vein isolation using high-power short-duration. J Cardiovasc Electrophysiol 2024; 35:60-68. [PMID: 37888200 DOI: 10.1111/jce.16119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/30/2023] [Accepted: 10/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Carina breakthrough (CB) at the right pulmonary vein (RPV) can occur after circumferential pulmonary vein isolation (PVI) due to epicardial bridging or transient tissue edema. High-power short-duration (HPSD) ablation may increase the incidence of RPV CB. Currently, the surrogate of ablation parameters to predict RPV CB is not well established. This study investigated predictors of RPV CB in patients undergoing ablation index (AI)-guided PVI with HPSD. METHODS The study included 62 patients with symptomatic atrial fibrillation (AF) who underwent AI-guided PVI using HPSD. Patients were categorized into two groups based on the presence or absence of RPV CB. Lesions adjacent to the RPV carina were assessed, and CB was confirmed through residual voltage, low voltage along the ablation lesions, and activation wavefront propagation. RESULTS Out of the 62 patients, 21 (33.87%) experienced RPV CB (Group 1), while 41 (66.13%) achieved first-pass RPV isolation (Group 2). Despite similar AI and HPSD, patients with RPV CB had lower contact force (CF) at lesions adjacent to the RPV carina. Receiver operating characteristic (ROC) curve analysis identified CF < 10.5 g as a predictor of RPV CB, with 75.7% sensitivity and 56.2% specificity (area under the curve: 0.714). CONCLUSION In patients undergoing AI-guided PVI with HPSD, lower CF adjacent to the carina was associated with a higher risk of RPV CB. These findings suggest that maintaining higher CF during ablation in this region may reduce the occurrence of RPV CB.
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Affiliation(s)
- Wei-Tso Chen
- Department of Medicine, Division of Cardiology, Hualien Tzu Chi, Hospital, Hualien, Taiwan
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Po Chung
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Chin-Yu Lin
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Ting-Yung Chang
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Ling Kuo
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Cheng-I Wu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Shin-Huei Liu
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang-Ming Chiao-Tung University School of Medicine, Taipei, Taiwan
| | - Yu-Cheng Hsieh
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - Cheng-Hung Li
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
| | - Shih-Ann Chen
- Department of Medicine, Division of Cardiology, Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Taichung Veterans General Hospital, Cardiovascular Center, Taichung, Taiwan
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Bahlke F, Wachter A, Erhard N, Englert F, Krafft H, Popa M, Risse E, Kottmaier M, Telishevska M, Lengauer S, Lennerz C, Reents T, Hessling G, Deisenhofer I, Bourier F. The influence of electrode-tissue-coverage on RF lesion formation and local impedance: Insights from an ex vivo model. Pacing Clin Electrophysiol 2023; 46:1170-1181. [PMID: 37616376 DOI: 10.1111/pace.14807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/16/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The influence of power, duration and contact force (CF) on radiofrequency (RF) lesion formation is well known, whereas data on local impedance (LI) and electrode-tissue-coverage (ETC) is scarce. The objective was to investigate their effect on lesion formation in an ex vivo model. METHODS AND RESULTS An ex vivo model was developed utilizing cross-sections of porcine heart preparations and a force-sensing, LI-measuring catheter. N = 72 lesion were created systematically varying ETC (minor/full), CF (1-5 g, 10-15 g, 20-25 g) and power (20 W, 30 W, 40 W, 50 W). In minor ETC, the distal tip of the catheter was in electric contact with the tissue, in full ETC the whole catheter tip was embedded within the tissue. Lesion size and all parameters were measured once per second (n = 3320). LI correlated strongly with lesion depth (r = -0.742 for ΔLI; r = 0.781 for %LI-drop). Lesions in full ETC were significantly wider and deeper compared to minor ETC (p < .001) and steam pops were more likely. Baseline LI, ΔLI, and %LI-drop were significantly higher in full ETC (p < .001). In lesions resulting in steam pops, baseline LI, and ΔLI were significantly higher. The influence of CF on lesion size was higher in minor ETC than in full ETC. CONCLUSIONS ETC is a main determinant of lesion size and occurrence of steam pops. Baseline LI and LI-drop are useful surrogate parameters for real-time assessment of ETC and ΔLI correlates strongly with lesion size.
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Affiliation(s)
- Fabian Bahlke
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Andreas Wachter
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Nico Erhard
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Florian Englert
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Hannah Krafft
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Miruna Popa
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Elena Risse
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Marc Kottmaier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Marta Telishevska
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Sarah Lengauer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Carsten Lennerz
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Tilko Reents
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich (TUM), Munich, Germany
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Kawakami S, Ogawa E, Fukaya H, Matsuura G, Aiga S, Kumagai H. Estimation of mechanical properties by transcatheter monitoring using local impedance and contact force. J Med Eng Technol 2023; 47:141-146. [PMID: 36426804 DOI: 10.1080/03091902.2022.2134479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The mechanical properties of the myocardium in the left ventricle and right atrium were estimated by simultaneously measuring the local impedance (LI) and contact force (CF) using an ablation catheter. Radiofrequency catheter ablation (RFCA) is a well-established arrhythmia treatment. Monitoring the RF power, CF and properties of myocardium during RFCA are necessary to estimate the effect of ablation. Indices, such as CF, lesion size index and ablation index, do not include the myocardium mechanical properties. Therefore, there is the risk of side effects, such as cardiac tamponade, by excessive catheter indentation into vulnerable areas. We propose the simultaneous measurement of LI and CF for estimating the myocardial mechanical properties to reduce the side effects. In this study, an in vitro experimental system was constructed to measure LI and CF via the catheter. The relationship between the porcine myocardial tissue thickness and CF-LI curve was investigated using the left ventricle and right atrium. Power function coefficients approximating the CF-LI curve increased with thicker left ventricle. The thickness of the myocardium can be estimated by simultaneously measuring LI and CF. Intraoperative measurement of the myocardial mechanical properties can be used to determine the ablation conditions at each site.
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Affiliation(s)
- Sota Kawakami
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Emiyu Ogawa
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.,Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University Hospital, Kanagawa, Japan
| | - Gen Matsuura
- Department of Cardiovascular Medicine, Kitasato University Hospital, Kanagawa, Japan
| | - Sumire Aiga
- Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Hiroshi Kumagai
- Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.,Allied Health Sciences, Kitasato University, Kanagawa, Japan
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Fukaya H, Mori H, Oikawa J, Kawano D, Nakamura H, Ishizue N, Kishihara J, Hojo R, Tsutsui K, Ikeda Y, Kato R, Fukamizu S. Optimal local impedance parameters for successful pulmonary vein isolation in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2023; 34:71-81. [PMID: 36378816 DOI: 10.1111/jce.15748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/24/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Local impedance (LI) parameters of IntellaNav STABLEPOINT for successful pulmonary vein isolation (PVI) of atrial fibrillation (AF) remain unclear. The purpose of this study was to seek LI data achieving successful PVI. METHODS Consecutive AF patients who underwent catheter ablation with STABLEPOINT were prospectively enrolled in two centers. PVI was performed under a constant 35-or 40-watt power, 20-s duration, and >5-g contact force. The operators were blinded to the LI data. The characteristics of all ablation points with/without conduction gaps (Unsuccess or Success tags) after the first-attempt PVI were evaluated for the right/left PVs and anterior/posterior wall (RPV/LPV and AW/PW, respectively), and cutoff values of LI data were calculated for successful lesion formation. RESULTS A total of 5257 ablation points in 102 patients (65 [58-72] years old, 65.7% male) were evaluated. The LI drop values were higher in the Success tags than Unsuccess tags on the LPV-AW and RPV-AW/PW (p < .001), except for the LPV-PW (p = .105). The %LI drop values (LI drop/initial LI) were higher for the Success tags in all areas (15.8 [12.2%-19.6%] vs. 11.6 [9.7%-15.6%] in LPV-AW: p < .001, 15.0 [11.5%-19.3%] vs. 11.4 [8.7%-17.3%] in LPV-PW: p = .035, 15.3 [11.5%-19.4%] vs. 9.9 [8.1%-13.7%] in RPV-AW: p < .001, and 13.3 [10.1%-17.4%] vs. 8.1 [6.3%-9.5%] in RPV-PW, p < .001). The LI drop and %LI drop cutoff values were 20.0 ohms and 11.6%, respectively. CONCLUSIONS An insufficient LI drop with STABLEPOINT was associated with a gap formation during PVI, and the best cutoff values for the LI drop and %LI drop were 20.0 ohms and 11.6%, respectively.
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Affiliation(s)
- Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hitoshi Mori
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Daisuke Kawano
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hironori Nakamura
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Naruya Ishizue
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Kenta Tsutsui
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yoshifumi Ikeda
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Ritsushi Kato
- Department of Cardiovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
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Alken FA, Scherschel K, Kahle AK, Masjedi M, Meyer C. Combined contact force and local impedance dynamics during repeat atrial fibrillation catheter ablation. Front Physiol 2022; 13:1001719. [PMID: 36311229 PMCID: PMC9606811 DOI: 10.3389/fphys.2022.1001719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Optimal lesion formation during catheter-based radiofrequency current (RFC) ablation depends on electro-mechanical tip-tissue coupling measurable via contact force (CF) and local impedance (LI) monitoring. We aimed to investigate CF and LI dynamics in patients with previous atrial fibrillation (AF) ablation who frequently present with heterogenous arrhythmia substrate. Methods: Data from consecutive patients presenting for repeat AF or atrial tachycardia ablation using a novel open-irrigated single-tip ablation catheter were studied. RFC applications were investigated regarding CF, LI and the maximum LI drop (∆LI) for evaluation of ablation efficacy. ∆LI > 20 Ω was defined as a successful RFC application. Results: A total of 730 RFC applications in 20 patients were analyzed. Baseline CF was not associated with baseline LI (R = 0.06, p = 0.17). A mean CF < 8 g during ablation resulted in lower ∆LI (<8 g: 13 Ω vs. ≥ 8 g: 16 Ω, p < 0.001). Baseline LI showed a better correlation with ∆LI (R = 0.35, p < 0.001) compared to mean CF (R = 0.17, p < 0.001). Mean CF correlated better with ∆LI in regions of low (R = 0.31, p < 0.001) compared to high (R = 0.21, p = 0.02) and intermediate voltage (R = 0.17, p = 0.004). Combined CF and baseline LI predicted ∆LI > 20 Ω (area under the receiver operating characteristic curve (AUC) 0.75) better compared to baseline LI (AUC 0.72), mean CF (AUC 0.60), force-time integral (AUC 0.59) and local bipolar voltage (0.55). Conclusion: Combination of CF and LI may aid monitoring real-time catheter-tissue electro-mechanical coupling and lesion formation within heterogenous atrial arrhythmia substrate in patients with repeat AF or atrial tachycardia ablation.
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Affiliation(s)
- Fares-Alexander Alken
- Division of Cardiology, Angiology and Intensive Care, cNEP, Cardiac Neuro- and Electrophysiology Research Group, EVK Düsseldorf, Düsseldorf, Germany
| | - Katharina Scherschel
- Division of Cardiology, Angiology and Intensive Care, cNEP, Cardiac Neuro- and Electrophysiology Research Group, EVK Düsseldorf, Düsseldorf, Germany
- Department of Neurophysiology, Heinrich-Heine-University Düsseldorf, Medical Faculty, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany
| | - Ann-Kathrin Kahle
- Division of Cardiology, Angiology and Intensive Care, cNEP, Cardiac Neuro- and Electrophysiology Research Group, EVK Düsseldorf, Düsseldorf, Germany
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Mustafa Masjedi
- Division of Cardiology, Angiology and Intensive Care, cNEP, Cardiac Neuro- and Electrophysiology Research Group, EVK Düsseldorf, Düsseldorf, Germany
- Department of Neurophysiology, Heinrich-Heine-University Düsseldorf, Medical Faculty, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany
| | - Christian Meyer
- Division of Cardiology, Angiology and Intensive Care, cNEP, Cardiac Neuro- and Electrophysiology Research Group, EVK Düsseldorf, Düsseldorf, Germany
- Department of Neurophysiology, Heinrich-Heine-University Düsseldorf, Medical Faculty, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Düsseldorf, Germany
- *Correspondence: Christian Meyer,
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Kawano D, Mori H, Tsutsui K, Fukaya H, Tanaka N, Narita M, Sasaki W, Matsumoto K, Ikeda Y, Arai T, Nakano S, Kato R. Time dependency in the radiofrequency lesion formation for a local impedance guided catheter in an ex vivo experimental model. J Arrhythm 2022; 38:1080-1087. [DOI: 10.1002/joa3.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Daisuke Kawano
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Hitoshi Mori
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Kenta Tsutsui
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan
| | - Naomichi Tanaka
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Masataka Narita
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Wataru Sasaki
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Kazuhisa Matsumoto
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Yoshifumi Ikeda
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Takahide Arai
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Shintaro Nakano
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
| | - Ritsushi Kato
- Department of Cardiology Saitama Medical University, International Medical Center Hidaka Japan
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