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Comparative Study
. 2024 Dec;67(9):2051-2058.
doi: 10.1007/s10840-024-01870-3. Epub 2024 Jul 12.

Local impedance drop-guided versus lesion size index-guided pulmonary vein isolation

Evgeny Lian  1 , Robert Pantlik  2 , Vera Maslova  3 , Sven Willert  3 , Fabian Moser  3 , Andrew Remppis  2 , Derk Frank  3 , Thomas Demming  2
Affiliations
Comparative Study

Local impedance drop-guided versus lesion size index-guided pulmonary vein isolation

Evgeny Lian et al. J Interv Card Electrophysiol. 2024 Dec.

Abstract

Background: Local tissue impedance drop (LID) and lesion size index (LSI) technologies are valuable for predicting effective lesion formation. This study compares the acute and long-term efficacy of LID-guided versus LSI-guided pulmonary vein isolation (PVI) for atrial fibrillation treatment.

Methods: We retrospectively analyzed two patient groups undergoing radiofrequency PVI. In the LID-guided group (n = 35), ablation was performed without contact force monitoring, stopping at the LID plateau (target LID 12 Ohm posterior, 16 Ohm anterior). In the LSI-guided group (n = 31), ablation used contact force information with target LSI (5 anterior, 4 posterior). Both groups utilized a power of 40 W anterior and 30 W posterior, with < 6 mm inter-lesion distance. Gap mapping and touch-up ablation were done if necessary.

Results: PVI was achieved with a significantly shorter ablation time in the LSI-guided group (25 min [21;31] vs 30 [27;35], p = 0.035). PV gaps were more frequent in the LID-guided group (74% vs 42%, p = 0.016). Over 11.5 ± 2.9 months follow-up, arrhythmia recurrence was higher in the LID-guided group (34.3% vs 16.1%, p = 0.037). A redo procedure performed in 10 (28.6%) patients in the LID-guided group and 3 (9.7%) in the LSI-guided group showed chronic PV reconnections in 7 out of 10 (70%) and 2 out of 3 (67%) patients, respectively.

Conclusions: LSI-guided ablation results in shorter ablation time and fewer PV gaps compared to LID-guided ablation. Despite initial success, LID-guided ablation had higher arrhythmia recurrence and PV reconnections during long-term follow-up compared to LSI-guided ablation.

Keywords: Atrial fibrillation; Lesion size; Local impedance; Pulmonary vein isolation; Radiofrequency ablation.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Representative examples of 3D maps of the left atrium with antral circumferential PVI. A Local impedance traces during LID-guided ablation. B LSI-guided ablation. LID, local tissue impedance drop; LSI, local size index
Fig. 2
Fig. 2
Distribution of acute PV gaps in different segments of PV antra. LAA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RIPV, right inferior pulmonary vein; RSPS, right superior pulmonary vein; PV, pulmonary vein
Fig. 3
Fig. 3
Kaplan–Meier curves comparing arrhythmia recurrence in the two trial groups. LID, local tissue impedance drop; LSI, local size index
See this image and copyright information in PMC

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