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Aranyó J, Martínez-Falguera D, Teis A, Fadeuilhe E, Rodríguez-Leor O, Bazan V, Sarrias A, Tebe C, Villuendas R, Delgado V, Bayés-Genís A, Gálvez-Montón C, Bisbal F. Tissue Characteristics Underlying Endocardial Local Impedance Subtypes in Chronic myocardial Infarction. Heart Rhythm 2025:S1547-5271(25)02440-3. [PMID: 40383178 DOI: 10.1016/j.hrthm.2025.05.017] [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: 02/13/2025] [Revised: 05/01/2025] [Accepted: 05/12/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Local impedance (LI) mapping is feasible and provides additional tissue characterization of the ventricular tachycardia substrate. Data on tissue composition underlying the LI spectrum are lacking. OBJECTIVE To describe the tissue composition underlying different LI subtypes in a chronic myocardial infarction (MI) swine model. METHODS One month after non-reperfused anterior MI, eigtheen Landrace Large White pigs underwent delayed-enhancement cardiac magnetic resonance (DE-CMR) and endocardial left ventricular (LV) LI mapping. DE-CMR images were post-processed off-line to obtain LV wall thickness, scar subtypes, and border-zone (BZ) corridors, and were co-registered with LI maps. Tissue samples were obtained from abnormal LI sites. RESULTS Low LI zones exhibited more pronounced wall thinning compared to intermediate LI tissue (2.8±0.7 vs 3.8 ± 0.9 mm; P < 0.001) and correlated with DE-CMR dense endocardial scarring (91.4%) and with epicardial scarring (75% dense and 24% BZ tissue). Intermediate LI tissue exhibited predominantly subendocardial scarring, with more heterogeneous distribution (45% dense, 47% BZ, and 8% healthy tissue) and less epicardial involvement (73% healthy tissue). Most DE-CMR BZ corridors (75.6%) co-localized with intermediate LI tissue. Histologically, tissue from intermediate LI zones displayed less collagen I (P = 0.008), collagen III (P = 0.053), and collagen volume fraction (P = 0.021), and greater vascular density (P = 0.075), compared to low LI zones. CONCLUSIONS Areas of low LI had higher proportion of dense, transmural scar and wall thinning compared to intermediate LI areas. DE-CMR BZ corridors colocalized with intermediate LI in most cases. LI subtypes showed distinctive histological composition.
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Affiliation(s)
- Júlia Aranyó
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain; Department of Medicine, Autonomous University of Barcelona (UAB)
| | - Daina Martínez-Falguera
- ICREC Research Program, Germans Trias I Pujol Research Institute (IGTP), Badalona, Barcelona, Spain; Faculty of Medicine, University of Barcelona (UB), Spain
| | - Albert Teis
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Edgar Fadeuilhe
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - Oriol Rodríguez-Leor
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - Víctor Bazan
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - Axel Sarrias
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - Cristian Tebe
- Biostatistics Support and Research Unit, Germans Trias i Pujol Research Institute and Hospital (IGTP), Badalona, Barcelona, Spain
| | - Roger Villuendas
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
| | - Victoria Delgado
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain; Centre of Comparative Medicine and Bioimaging, Badalona, Spain
| | - Antoni Bayés-Genís
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Can Ruti Campus, Autonomous University of Barcelona, Spain
| | - Carolina Gálvez-Montón
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain; ICREC Research Program, Germans Trias I Pujol Research Institute (IGTP), Badalona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
| | - Felipe Bisbal
- Heart Institute (iCOR), Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain; CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain.
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Taormina A, Grossi B, Ragaini EM, Falasconi G, Penela D, Ceriotti C, Poggio L, Galimberti P, Latini AC, Carli S, Del Monaco G, Chiarito M, Sticchi A, Giunti F, Antonelli G, Preda A, Guarracini F, Mazzone P, Condorelli G. Correlation Between Voltage and Impedance Mapping in Patients with Atrial Fibrillation. J Clin Med 2024; 14:130. [PMID: 39797213 PMCID: PMC11720856 DOI: 10.3390/jcm14010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 12/24/2024] [Accepted: 12/26/2024] [Indexed: 01/13/2025] Open
Abstract
Background. Pulmonary vein isolation (PVI) represents the cornerstone of paroxysmal (PAF) and persistent atrial fibrillation (PsAF) ablation. Impedance values provide insights on tissue conductive properties. Methods. Consecutive patients undergoing PAF and PsAF ablation were prospectively enrolled. All the patients underwent a preprocedural multidetector computed tomography (MDCT) to evaluate left atrial wall thickness (LAWT). Electroanatomic maps were acquired with the ablation catheter, and impedance values (Ω) and voltage amplitude (mV) of bipolar electrograms were collected. Results. A total of 60 patients (40 with PAF and 20 with PsAF) were included in the study. In all PAF cases, no voltage value lower than 0.5 mV was found at LA mapping; the corresponding mean impedance value was 151.5 ± 5.4 Ω. In PsAF cases, voltage values inferior to 0.05 mV have been reported in 19/20 patients. PsAF patients showed a mean impedance value of 129.1 ± 3.8 Ω. The correlation analysis between bipolar voltage and impedance reported an rs value of 0.4166 (p < 0.001), showing a positive correlation between the two variables. On the contrary, no direct correlation was found between voltage and LAWT and between impedance and LAWT (rsv-t = 0.1838; rsi-t = 0.1133, respectively). Conclusions. This research study suggests a correlation between voltage amplitude and impedance values, so that impedance might be used for arrhythmogenic substrate characterization.
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Affiliation(s)
- Antonio Taormina
- Cardiac Arrhythmia Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 6, 20089 Rozzano, Italy; (D.P.); (C.C.); (P.G.); (A.C.L.); (S.C.); (G.D.M.); (F.G.); (G.A.)
| | - Benedetta Grossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
| | - Elisa Maria Ragaini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
| | - Giulio Falasconi
- Cardiac Arrhythmia Department, Teknon Medical Center, 08022 Barcelona, Spain;
| | - Diego Penela
- Cardiac Arrhythmia Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 6, 20089 Rozzano, Italy; (D.P.); (C.C.); (P.G.); (A.C.L.); (S.C.); (G.D.M.); (F.G.); (G.A.)
| | - Carlo Ceriotti
- Cardiac Arrhythmia Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 6, 20089 Rozzano, Italy; (D.P.); (C.C.); (P.G.); (A.C.L.); (S.C.); (G.D.M.); (F.G.); (G.A.)
| | - Luca Poggio
- Arrhythmia Unit, Ospedale Maggiore, 26900 Lodi, Italy;
| | - Paola Galimberti
- Cardiac Arrhythmia Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 6, 20089 Rozzano, Italy; (D.P.); (C.C.); (P.G.); (A.C.L.); (S.C.); (G.D.M.); (F.G.); (G.A.)
| | - Alessia Chiara Latini
- Cardiac Arrhythmia Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 6, 20089 Rozzano, Italy; (D.P.); (C.C.); (P.G.); (A.C.L.); (S.C.); (G.D.M.); (F.G.); (G.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
| | - Sebastiano Carli
- Cardiac Arrhythmia Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 6, 20089 Rozzano, Italy; (D.P.); (C.C.); (P.G.); (A.C.L.); (S.C.); (G.D.M.); (F.G.); (G.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
| | - Guido Del Monaco
- Cardiac Arrhythmia Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 6, 20089 Rozzano, Italy; (D.P.); (C.C.); (P.G.); (A.C.L.); (S.C.); (G.D.M.); (F.G.); (G.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
| | - Alessandro Sticchi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
| | - Filippo Giunti
- Cardiac Arrhythmia Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 6, 20089 Rozzano, Italy; (D.P.); (C.C.); (P.G.); (A.C.L.); (S.C.); (G.D.M.); (F.G.); (G.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
| | - Giulia Antonelli
- Cardiac Arrhythmia Department, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 6, 20089 Rozzano, Italy; (D.P.); (C.C.); (P.G.); (A.C.L.); (S.C.); (G.D.M.); (F.G.); (G.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
| | - Alberto Preda
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, 20162 Milan, Italy; (A.P.); (F.G.); (P.M.)
| | - Fabrizio Guarracini
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, 20162 Milan, Italy; (A.P.); (F.G.); (P.M.)
| | - Patrizio Mazzone
- De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, 20162 Milan, Italy; (A.P.); (F.G.); (P.M.)
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (B.G.); (E.M.R.); (M.C.); (A.S.); (G.C.)
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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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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: 6] [Impact Index Per Article: 2.0] [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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