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. 2023 Jul 5:10:1169037.
doi: 10.3389/fcvm.2023.1169037. eCollection 2023.

Insight into contact force local impedance technology for predicting effective pulmonary vein isolation

Antoine Lepillier #  1 , Ruggero Maggio #  2 , Valerio De Sanctis  3 , Maurizio Malacrida  4 , Giuseppe Stabile  5 , Cyril Zakine  6 , Laure Champ-Rigot  7 , Matteo Anselmino  8 , Luca Segreti  9 , Gabriele Dell'Era  10 , Fabien Garnier  11 , Giuseppe Mascia  12 , Claudio Pandozi  13 , Antonio Dello Russo  14 , Marco Scaglione  15 , Giuseppe Cosaro  4 , Anna Ferraro  2 , Olivier Paziaud  1 , Giampiero Maglia  16 , Francesco Solimene  17
Affiliations

Insight into contact force local impedance technology for predicting effective pulmonary vein isolation

Antoine Lepillier et al. Front Cardiovasc Med. .

Abstract

Background: Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have the potential to act as a reliable predictor of the durability of the lesions created.

Objective: We aimed to collect data on the procedural parameters affecting LI-guided ablation in a large multicenter registry.

Methods: A total of 212 consecutive patients enrolled in the CHARISMA registry and undergoing their first pulmonary vein (PV) isolation for paroxysmal and persistent AF were included.

Results: In all, 13,891 radiofrequency (RF) applications of ≥3 s duration were assessed. The first-pass PV isolation rate was 93.3%. A total of 80 PV gaps were detected. At successful ablation spots, baseline LI and absolute LI drop were larger than at PV gap spots (161.4 ± 19 Ω vs. 153.0 ± 13 Ω, p < 0.0001 for baseline LI; 22.1 ± 9 Ω vs. 14.4 ± 5 Ω, p < 0.0001 for LI drop). On the basis of Receiver operating characteristic curve analysis, the ideal LI drop, which predicted successful ablation, was >21 Ω at anterior sites and >18 Ω at posterior sites. There was a non-linear association between the magnitude of LI drop and contact-force (CF) (r = 0.14, 95% CI: 0.13-0.16, p < 0.0001) whereas both CF and LI drop were inversely related with delivery time (DT) (-0.22, -0.23 to -0.20, p < 0.0001 for CF; -0.27, -0.29 to -0.26, p < 0.0001 for LI drop).

Conclusion: An LI drop >21 Ω at anterior sites and >18 Ω at posterior sites predicts successful ablation. A higher CF was associated with an increased likelihood of ideal LI drop. The combination of good CF and adequate LI drop allows a significant reduction in RF DT.

Clinical trial registration: http://clinicaltrials.gov/, identifier: NCT03793998.

Keywords: atrial fibrillation; catheter ablation; contact force; lesion formation; local impedance; pulmonary vein isolation.

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Conflict of interest statement

MM and GC are employees of Boston Scientific. MA is a consultant for Boston Scientific and Biosense Webster and a clinical proctor for Medtronic, and has received educational fees from Abbott. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor TS declared a past co-authorship with the author FS.

Figures

Figure 1
Figure 1
Procedural parameters according to ablation site (anterior vs. posterior).
Figure 2
Figure 2
Distribution of PV gaps in patients without first-pass isolation.
Figure 3
Figure 3
Procedural parameters at successful ablation spots and PV gaps (first-pass isolation sites vs. PV gap sites). FPI, first-pass isolation; FPNA, first-pass isolation not achieved.
Figure 4
Figure 4
Correlation between key procedural parameters. Radar plots (on the left) showing the relationship between RF delivery time and CF values according to different degrees of LI drop (A); RF delivery time and LI drop values according to different degrees of CF (B); and LI drop and CF values according to different degrees of RF delivery time (C). Details of relationships among the three key parameters (on the right): RF delivery time and LI drop according to different levels of CF (A); RF delivery time and CF according to different degrees of LI drop (B); and CF and LI drop according to different values of RF delivery time (C).
See this image and copyright information in PMC

References

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