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Gunawardene M, Münkler P, Eickholt C, Akbulak RÖ, Jularic M, Klatt N, Hartmann J, Dinshaw L, Jungen C, Moser JM, Merbold L, Willems S, Meyer C. A novel assessment of local impedance during catheter ablation: initial experience in humans comparing local and generator measurements. Europace 2020; 21:i34-i42. [PMID: 30801126 DOI: 10.1093/europace/euy273] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 11/10/2018] [Indexed: 11/14/2022] Open
Abstract
AIMS A novel measure of local impedance (LI) has been found to predict lesion formation during radiofrequency current (RFC) catheter ablation. The aim of this study was to investigate the utility of this novel approach, while comparing LI to the well-established generator impedance (GI). METHODS AND RESULTS In 25 consecutive patients with a history of atrial fibrillation, catheter ablation was guided by a 3D-mapping system measuring LI in addition to GI via an ablation catheter tip with three incorporated mini-electrodes. Local impedance and GI before and during RFC applications were studied. In total, 381 RFC applications were analysed. The baseline LI was higher in high-voltage areas (>0.5 mV; LI: 110.5 ± 13.7 Ω) when compared with intermediate-voltage sites (0.1-0.5 mV; 90.9 ± 10.1 Ω, P < 0.001), low-voltage areas (<0.1 mV; 91.9 ± 16.4 Ω, P < 0.001), and blood pool LI (91.9 ± 9.9 Ω, P < 0.001). During ablation, mean LI drop (△LI; 13.1 ± 9.1 Ω) was 2.15 times higher as mean GI drop (△GI) (6.1 ± 4.2 Ω, P < 0.001). Baseline LI correlated with △LI: a mean LI of 99.9 Ω predicted a △LI of 12.9 Ω [95% confidence interval (12.1-13.6), R2 0.41; P < 0.001]. This relationship was weak for baseline GI predicting △GI (R2 0.06, P < 0.001). Catheter movements were represented by rapid LI changes. The duration of an RFC application was not predictive for catheter-tissue coupling with no further change of △LI (P = 0.247) nor △GI (P = 0.376) during prolonged ablation. CONCLUSION Local impedance can be monitored during ablation. Compared with the sole use of GI, baseline LI is a better predictor of impedance drops during ablation and may provide useful insights regarding lesion formation. However, further studies are needed to investigate if this novel approach is useful to guide catheter ablation.
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Affiliation(s)
- Melanie Gunawardene
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Paula Münkler
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Christian Eickholt
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Niklas Klatt
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Julia M Moser
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany
| | | | - Stephan Willems
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Christian Meyer
- Department of Cardiac Electrophysiology, University Heart Center, University Hospital Hamburg Eppendorf, Martinistrasse 52, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Berlin, Germany
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52
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Sasaki T, Nakamura K, Inoue M, Minami K, Miki Y, Goto K, Take Y, Kaseno K, Yamashita E, Koyama K, Naito S. Optimal local impedance drops for an effective radiofrequency ablation during cavo-tricuspid isthmus ablation. J Arrhythm 2020; 36:905-911. [PMID: 33024468 PMCID: PMC7532274 DOI: 10.1002/joa3.12403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE A novel ablation catheter capable of local impedance (LI) monitoring (IntellaNav MiFi OI, Boston Scientific) has been recently introduced to clinical practice. We aimed to determine the optimal LI drops for an effective radiofrequency ablation during cavo-tricuspid isthmus (CTI) ablation. METHODS This retrospective observational study enrolled 50 consecutive patients (68 ± 9 years; 34 males) who underwent a CTI ablation using the IntellaNav MiFi OI catheter, guided by Rhythmia. The LI at the start of radiofrequency applications (initial LI) and minimum LI during radiofrequency applications were evaluated. The absolute and percentage LI drops were defined as the difference between the initial and minimum LIs and 100× absolute LI drop/initial LI, respectively. RESULTS A total of 518 radiofrequency applications were analyzed. The absolute and percentage LI drops were significantly greater at effective ablation sites than ineffective sites (median, 15 ohms vs 8 ohms, P < .0001; median, 14.7% vs 8.3%, P < .0001). A receiver-operating characteristic analysis demonstrated that at optimal cutoffs of 12 ohms and 11.6% for the absolute and percentage LI drops, the sensitivity and specificity for predicting the effectiveness of the ablation were 66.5% and 88.2%, and 65.1% and 88.2%, respectively. Finally, bidirectional conduction block along the CTI was achieved in all patients. CONCLUSIONS During the LI-guided CTI ablation, the effective RF ablation sites exhibited significantly greater absolute and percentage LI drops than the ineffective RF ablation sites. Absolute and percentage LI drops of 12 ohms and 11.6% may be suitable targets for effective ablation.
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Affiliation(s)
- Takehito Sasaki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kohki Nakamura
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Mitsuho Inoue
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kentaro Minami
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Yuko Miki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Koji Goto
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Yutaka Take
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Kenichi Kaseno
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Eiji Yamashita
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Keiko Koyama
- Division of Radiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
| | - Shigeto Naito
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi City Japan
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53
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Segreti L, De Simone A, Schillaci V, Bongiorni MG, Pelargonio G, Pandozi C, Di Cori A, Stabile G, Pepe M, Zucchelli G, Shopova G, De Lucia R, Ferrari C, Casati F, Malacrida M, Solimene F. A novel local impedance algorithm to guide effective pulmonary vein isolation in atrial fibrillation patients: Preliminary experience across different ablation sites from the CHARISMA pilot study. J Cardiovasc Electrophysiol 2020; 31:2319-2327. [PMID: 32613661 DOI: 10.1111/jce.14647] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Recently, a novel technology able to measure local impedance (LI) and tissue characteristics has been made available for clinical use. This analysis explores the relationships among LI and generator impedance (GI) parameters in atrial fibrillation (AF) patients. Characterization of LI among different ablation spots and procedural success were also evaluated. METHODS AND RESULTS Consecutive patients undergoing AF ablation from the CHARISMA registry at five Italian centers were included. A novel radiofrequency (RF) ablation catheter with a dedicated algorithm (DIRECTSENSE™) was used to measure LI and to guide ablation. The ablation endpoint was pulmonary vein (PV) isolation. We analyzed 2219 ablation spots created around PVs in 46 patients for AF ablation. The mean baseline tissue impedance was 105.8 ± 14 Ω for LI versus 91.8 ± 10 Ω for GI (p < .0001). Baseline impedance was homogenous across the PV sites and proved higher in high-voltage areas than in intermediate- and low-voltage areas and the blood pool (p < .001). Both LI and GI displayed a significant drop after RF delivery, and absolute LI drop values were significantly larger than GI drop values (14 ± 8 vs. 3.7 ± 5 Ω, p < .0001). Every 5-point increment in LI drop was associated with successful ablation (odds ratio = 3.05, 95% confidence interval: 2.3-4.1, p < .0001). Conversely, GI drops were not significantly different comparing successful versus unsuccessful sites (3.7 ± 5 vs. 2.8 ± 4 Ω, p = .1099). No steam pops or major complications occurred during or after the procedures. By the end of the procedures, all PVs had been successfully isolated in all patients. CONCLUSIONS The magnitude of the LI drop was more closely associated with effective lesion formation than the GI drop.
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Affiliation(s)
- Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Antonio De Simone
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Vincenzo Schillaci
- Laboratorio di Elettrofisiologia, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Thoracic Sciences, Catholic University of Sacred Heart, Rome, Italy
| | - Claudio Pandozi
- Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Andrea Di Cori
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Stabile
- Laboratorio di Elettrofisiologia, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Marco Pepe
- Laboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, Caserta, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gergana Shopova
- Laboratorio di Elettrofisiologia, Clinica Montevergine, Mercogliano, Avellino, Italy
| | - Raffaele De Lucia
- Second Division of Cardiology, Cardiac-Thoracic-Vascular Department, New Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | | | - Francesco Solimene
- Laboratorio di Elettrofisiologia, Clinica Montevergine, Mercogliano, Avellino, Italy
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54
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Garrott K, Laughner J, Gutbrod S, Sugrue A, Shuros A, Sulkin M, Yasin O, Bush J, Pottinger N, Meyers J, Kapa S. Combined local impedance and contact force for radiofrequency ablation assessment. Heart Rhythm 2020; 17:1371-1380. [PMID: 32240822 DOI: 10.1016/j.hrthm.2020.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The combination of contact force (CF) and local impedance (LI) may improve tissue characterization and lesion prediction during radiofrequency (RF) ablation. OBJECTIVE The purpose of this study was to evaluate the utility of LI combined with CF in assessing RF ablation efficacy. METHODS An LI catheter with CF sensing was evaluated in swine (n = 11) and in vitro (n = 14). The relationship between LI and CF in different tissue types was evaluated in vivo. Discrete lesions were created in vitro and in vivo at a range of forces, powers, and durations. Finally, an intercaval line was created in 3 groups at 30 W: 30s, Δ20Ω, and Δ30Ω. In the Δ20Ω and Δ30Ω groups, the user ablated until a 20 or 30 Ω LI drop. In the 30s group, the user was blinded to LI. RESULTS In vivo, distinction in LI was found between the blood pool and the myocardium (blood pool: 122 ± 7.02 Ω; perpendicular contact: 220 ± 29 Ω; parallel contact: 207 ± 31 Ω). LI drop correlated with lesion depth both in vitro (R = 0.84) and in vivo (R = 0.79), informing sufficient lesion creation (LI drop >20 Ω) and warning of excessive heating (LI drop >65 Ω). When creating an intercaval line, the total RF time was significantly reduced when using LI guidance (6.4 ± 2 minutes in Δ20Ω and 8.1 ± 1 minutes in Δ30Ω) compared with a standard 30-second workflow (18 ± 7 minutes). Acute conduction block was achieved in all Δ30Ω and 30s lines. CONCLUSION The addition of LI to CF provides feedback on both electrical and mechanical loads. This provides information on tissue type and catheter-tissue coupling; provides feedback on whether volumetric tissue heating is inadequate, sufficient, or excessive; and reduces ablation time.
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Affiliation(s)
- Kara Garrott
- Boston Scientific Corporation, St. Paul, Minnesota
| | | | | | - Alan Sugrue
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Allan Shuros
- Boston Scientific Corporation, St. Paul, Minnesota
| | - Matt Sulkin
- Boston Scientific Corporation, St. Paul, Minnesota
| | - Omar Yasin
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jamie Bush
- Boston Scientific Corporation, St. Paul, Minnesota
| | | | - Jason Meyers
- Heart Rhythm Center, Iowa Heart Center, West Des Moines, Iowa
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
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55
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Friedman DJ, Overmann JA, Fish JM, Gaeta SA, Tranter JH, Thao R, Piccini JP. Impact of interruptions in radiofrequency energy delivery on lesion characteristics. Heart Rhythm 2020; 17:1354-1359. [PMID: 32200047 DOI: 10.1016/j.hrthm.2020.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 03/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND During catheter ablation, delivery of radiofrequency (RF) energy to a target site is sometimes interrupted by catheter instability and clinical factors. The impact of interruption of RF delivery on lesion characteristics has not been characterized. OBJECTIVE The purpose of this study was to determine the impact of interruption of RF application on lesion size. METHODS Forty-two RF ablation lesions (21 left ventricle, 21 right ventricle) were created in the ventricles of 6 swine using power control mode (30 W; target contact force 15g) with 1 of 3 conditions: 15-second ablation (15s), 30-second ablation (30s), or two 15-second ablations (15s×2) at the same site separated by a 2-minute pause. RESULTS Lesion volume was significantly larger for 30s lesions (501 ± 146 mm3) compared to both 15s×2 (314 ± 98 mm3) and 15s (242 ± 104 mm3) lesions (P <.001 for both pairwise comparisons). Compared to 15s lesions, lesion volume was numerically greater for 15s×2 lesions, but this did not reach statistical significance (P = .087). Differences in lesion volume between 30s and 15s×2 lesions were driven mainly by differences in lesion width (10.7 ± 1.1 mm vs 9.1 ± 1.7 mm; P = .04) rather than depth (9 ± 1.2 mm vs 8.4 ± 1.2 mm; P = .29). There were no differences in mean contact force by group. There was no difference in total force-time integral for the 30s and 15s×2 lesion groups [median 444 (interquartile range 312) g∙s vs 380 (164) g∙s; P = 1]. CONCLUSION Compared to lesions resulting from continuous RF ablation, lesions resulting from interrupted ablation have a smaller overall lesion volume, predominantly due to smaller lesion width. These data suggest that if disruption in energy delivery occurs, lesions may need closer spacing to avoid gaps.
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Affiliation(s)
- Daniel J Friedman
- Electrophysiology Section, Duke University Hospital, Durham, North Carolina
| | | | | | - Stephen A Gaeta
- Electrophysiology Section, Duke University Hospital, Durham, North Carolina; Inova Heart and Vascular, Falls Church, Virginia
| | | | | | - Jonathan P Piccini
- Electrophysiology Section, Duke University Hospital, Durham, North Carolina.
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56
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Borlich M, Sommer P. Cardiac Mapping Systems: Rhythmia, Topera, EnSite Precision, and CARTO. Card Electrophysiol Clin 2020; 11:449-458. [PMID: 31400869 DOI: 10.1016/j.ccep.2019.05.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Novel cardiac mapping systems allow a safe and highly accurate 3-D reconstruction of cardiac structures as well as fast and accurate visualization of cardiac arrhythmias. In addition, they are increasingly reducing the need for fluoroscopy in these procedures. The current state of the art, as well as the presentation of possible uses of individual systems and their limitations, is presented in this article. Cardiac mapping systems can significantly contribute to an optimal therapeutic decision making in invasive electrophysiology. This article introduces new developments of Rhythmia, Topera, EnSite Precision, and CARTO systems and provides a look ahead to the future.
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Affiliation(s)
- Martin Borlich
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein 23795, Germany.
| | - Philipp Sommer
- Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum, Georgstr. 11, Bad Oeynhausen, Nordrhein-Westfalen 32545, Germany
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57
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Zhao Z, Liu X, Gao L, Xi Y, Chen Q, Chang D, Xiao X, Cheng J, Yang Y, Xia Y, Yin X. Benefit of Contact Force-Guided Catheter Ablation for Treating Premature Ventricular Contractions. Tex Heart Inst J 2020; 47:3-9. [PMID: 32148445 DOI: 10.14503/thij-17-6441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We evaluated whether an irrigated contact force-sensing catheter would improve the safety and effectiveness of radiofrequency ablation of premature ventricular contractions originating from the right ventricular outflow tract. We retrospectively reviewed the charts of patients with symptomatic premature ventricular contractions who underwent ablation with a contact force-sensing catheter (56 patients, SmartTouch) or conventional catheter (59 patients, ThermoCool) at our hospital from August 2013 through December 2015. During a mean follow-up of 16 ± 5 months, 3 patients in the conventional group had recurrences, compared with none in the contact force group. Complications occurred only in the conventional group (one steam pop; 2 ablations suspended because of significantly increasing impedance). In the contact force group, the median contact force during ablation was 10 g (interquartile range, 7-14 g). Times for overall procedure (36.9 ± 5 min), fluoroscopy (86.3 ± 22.7 s), and ablation (60.3 ± 21.4 s) were significantly shorter in the contact force group than in the conventional group (46.2 ± 6.2 min, 107.7 ± 30 s, and 88.7 ± 32.3 s, respectively; P <0.001). In the contact force group, cases with a force-time integral <560 gram-seconds (g-s) had significantly longer procedure and fluoroscopy times (both P <0.001) than did those with a force-time integral ≥560 g-s. These findings suggest that ablation of premature ventricular contractions originating from the right ventricular outflow tract with an irrigated contact force-sensing catheter instead of a conventional catheter shortens overall procedure, fluoroscopy, and ablation times without increasing risk of recurrence or complications.
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58
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Münkler P, Gunawardene MA, Jungen C, Klatt N, Schwarzl JM, Akbulak RÖ, Dinshaw L, Hartmann J, Jularic M, Kahle AK, Riedel R, Merbold L, Eickholt C, Willems S, Meyer C. Local impedance guides catheter ablation in patients with ventricular tachycardia. J Cardiovasc Electrophysiol 2019; 31:61-69. [PMID: 31701589 DOI: 10.1111/jce.14269] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/16/2019] [Accepted: 11/04/2019] [Indexed: 12/27/2022]
Abstract
AIMS Catheter contact and local tissue characteristics are relevant information for successful radiofrequency current (RFC)-ablation. Local impedance (LI) has been shown to reflect tissue characteristics and lesion formation during RFC-ablation. Using a novel ablation catheter incorporating three mini-electrodes, we investigated LI in relation to generator impedance (GI) in patients with ventricular tachycardia (VT) and its applicability as an indicator of effective RFC-ablation. METHODS AND RESULTS Baseline impedance, Δimpedance during ablation and drop rate (Δimpedance/time) were analyzed for 625 RFC-applications in 28 patients with recurrent VT undergoing RFC-ablation. LI was lower in scarred (87.0 Ω [79.0-95.0]) compared to healthy myocardium (97.5 Ω ([82.75-111.50]; P = .03) while GI did not differ between scarred and healthy myocardium. ΔLI was higher (18 Ω [9.4-26.0]) for VT-terminating as compared to non-terminating RFC-ablation (ΔLI 13 Ω [8.85-18.0]; P = .03), but did not differ for ΔGI between terminating vs nonterminating RFC-ablation. Correspondingly, LI drop rate was higher for RFC-ablation terminating the VT compared with RFC-ablation not terminating the VT (0.63 Ω/s [0.52-0.76] vs 0.32 Ω [0.20-0.58]; P = .008) while there was no difference for GI drop rate. ΔLI was higher in patients with nonischemic cardiomyopathy vs patients with ischemic cardiomyopathy (16 Ω [11.0-20.0] vs 11.0 Ω [7.85-17.00]; P = .003). CONCLUSION Our findings suggest that LI is a sensitive parameter to guide RFC-ablation in patients with VT. LI indicates differences in tissue characteristics and generally is higher in patients with nonischemic cardiomyopathy. Hence, the etiology of the underlying cardiomyopathy needs to be considered when adopting LI for monitoring catheter ablation of VT.
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Affiliation(s)
- Paula Münkler
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Melanie A Gunawardene
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Niklas Klatt
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Jana M Schwarzl
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Ruken Ö Akbulak
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Leon Dinshaw
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Mario Jularic
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Ann-Kathrin Kahle
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - René Riedel
- Max Planck Institute for Evolutionary Biology, Plön, Germany
| | | | - Christian Eickholt
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Stephan Willems
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,Department of Cardiology, Asklepios Hospital St. Georg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Christian Meyer
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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García-Bolao I, Ramos P, Ballesteros G, Vives E. New mapping tools to assess lesion in atrial fibrillation. Europace 2019; 21:iii2-iii4. [DOI: 10.1093/europace/euz110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ignacio García-Bolao
- Department of Cardiology and Cardiac Surgery, Clínica Universidad de Navarra, Avda. Pío XII 36, Pamplona, Spain
| | - Pablo Ramos
- Department of Cardiology and Cardiac Surgery, Clínica Universidad de Navarra, Avda. Pío XII 36, Pamplona, Spain
| | - Gabriel Ballesteros
- Department of Cardiology and Cardiac Surgery, Clínica Universidad de Navarra, Avda. Pío XII 36, Pamplona, Spain
| | - Enrique Vives
- Department of Cardiology and Cardiac Surgery, Clínica Universidad de Navarra, Avda. Pío XII 36, Pamplona, Spain
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Stein KM, Sulkin MS, Stivland TM. Advancing electrophysiology: partnerships achieve meaningful innovation. Europace 2019; 21:iii29-iii31. [DOI: 10.1093/europace/euz170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kenneth M Stein
- Cardiac Electrophysiology, Boston Scientific Incorporation, 4100 Hamline Avenue North, Arden Hills, MN, USA
| | - Matthew S Sulkin
- Cardiac Electrophysiology, Boston Scientific Incorporation, 4100 Hamline Avenue North, Arden Hills, MN, USA
| | - Timothy M Stivland
- Cardiac Electrophysiology, Boston Scientific Incorporation, 4100 Hamline Avenue North, Arden Hills, MN, USA
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61
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Electrogram voltage and pacing threshold before ablation, measured by mini-electrodes, predict parameters indicative of transmural lesions in the human atrium. J Interv Card Electrophysiol 2019; 57:443-452. [PMID: 31049825 PMCID: PMC7196083 DOI: 10.1007/s10840-019-00539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/12/2019] [Indexed: 10/31/2022]
Abstract
PURPOSE An important attenuation of the atrial signal recorded with mini-electrodes (ME) embedded in an 8-mm tip was associated with a transmural radiofrequency lesion. Our aim was to assess if parameters obtained from ME or conventional bipoles before applications predict successful atrial lesions. METHODS We prospectively included 33 consecutive patients undergoing cavotricuspid isthmus (CTI) ablation. Electrogram voltages and pacing thresholds were measured with ME and conventional bipoles before and after radiofrequency (RF) applications. The time before the loss of capture during applications was recorded. Lesions were considered successful, in accordance with preclinical data, if ME voltage decreased > 54%. RESULTS Of 207 applications, 107 could be analyzed. During applications, voltages decreased more in the ME than in the conventional bipoles (66.8 ± 26.1% vs 37.5 ± 42.5%, P = 0.001). Likewise, pacing threshold increased significantly more using the ME (86.3 ± 22.9% ME, 52.6 ± 35.6% conventional, P = 0.001). ME pre-ablation voltages were significantly higher and pacing thresholds significantly lower in successful lesions (voltage 0.88 ± 0.71 vs 0.26 ± 0.18 mV, P = 0.0001; threshold 1.6 ± 1.7 vs 2.8 ± 3.0, P = 0.04). Neither of these parameters with conventional bipoles nor time to loss of capture showed differences. A ME voltage > 0.33 mV and a pacing threshold < 1.5 mA predicted a successful lesion with 0.78 and 0.6 sensitivity and 0.78 and 0.59 specificity. CONCLUSIONS Certain pre-ablation parameters derived from ME such as electrogram voltage and pacing threshold differ from those obtained by a conventional configuration and can predict a successful atrial lesion.
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Jilek C, Ullah W. Pulmonary vein reconnections or substrate in the left atrium: what is the reason for atrial fibrillation recurrences? A dialogue on a pressing clinical situation. Europace 2019; 21:i12-i20. [DOI: 10.1093/europace/euy289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 01/05/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Clemens Jilek
- Internistisches Klinikum München Süd, Peter-Osypka-Heart Centre, Munich, Germany
| | - Waqas Ullah
- Cardiology Department, University Hospital Southampton, National Health Service Foundation Trust, Southampton, UK
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John RM, Stevenson WG. A new impedance-based method to guide RF ablation: Still scratching the surface? J Cardiovasc Electrophysiol 2018; 29:1207-1209. [PMID: 29949216 DOI: 10.1111/jce.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Roy M John
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center Nashville, Nashville, Tennessee
| | - William G Stevenson
- Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center Nashville, Nashville, Tennessee
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