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Requirement of larger local impedance reduction for successful lesion formation at carinal area during pulmonary vein isolation

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Local impedance (LI) measurement from an ablation catheter is useful in predicting lesion size and acute success of pulmonary vein isolation (PVI). The LI variation can be described by absolute LI drop (ΔLID) or ΔLID/initial LI (%LID). We evaluated the utility of these parameters in predicting acute lesion durability during PVI using a novel catheter capable of measuring both LI and contact force (CF).

Methods

PVI with a targeted CF, power, and duration was performed in 23 consecutive patients with paroxysmal atrial fibrillation. LI was blinded to operators during ablation. Parameters for each RF application were collected and compared for acute successful lesions and gaps.

Results

A total of 1633 RF applications including 97 (5.9%) gap lesions were analyzed. Successful lesions were more frequently observed at non-carinal sites and those with higher contact force, FTI, initial LI, and larger variation of LI and generator impedance (GI). Multivariate analysis demonstrated that absolute GI drop (ΔGID) [OR 1.09 (1.04–1.15), p < 0.001], ΔLID [1.12 (1.09–1.16), p < 0.001], ΔGID/initial GI (%GID) [OR 1.04 (1.01–1.07), p = 0.01], and %LID [OR 1.15 (1.12–1.28), p < 0.001] were significantly associated with successful lesions, and carinal site [OR 0.15(0.09–0.24), p < 0.001] was significantly related to gaps. Both ΔLID and %LID equally predicted the acute durability of lesions during PVI. ΔLID ≥ 24Ω and %LID ≥ 15% at the carina, and ΔLID ≥ 21Ω and %LID ≥ 14% at non-carinal sites significantly predicted acute successful lesions with negative predictive values of 93–99%.

Conclusions

Both ΔLID and %LID were equally useful in predicting acute successful lesions during PVI. Larger cut-off values should be applied to carinal sites.

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Acknowledgements

We are grateful to Mr. Tomohiro Nagao, an employee of Boston Scientific Japan, for a technical support of this study.

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Author notes

  1. Dr. Ikenouchi and Dr. Takigawa equally contributed to this study as first authors.

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Takashi Ikenouchi, Masateru Takigawa, Masahiko Goya, Yoshihide Takahashi, Yuki Shimizu, Miki Amemiya, Tatsuaki Kamata, Takuro Nishimura, Susumu Tao, Shinsuke Miyazaki & Tetsuo Sasano

  2. Department of Cardiology, Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge, CB2 OAY, UK

    Claire A. Martin

Authors
  1. Takashi Ikenouchi
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  2. Masateru Takigawa
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  4. Claire A. Martin
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Contributions

Each author contributes to this study as follows:

・Conception and design of the study: Masateru Takigawa (M.T) and Takashi Ikenouchi (T.I).

Acquisition of data: Yuki Shimizu (Y.S), Miki Amemiya (M.A), Tatsuaki Kamata (T.K), Takurou Nishimura (T.N), Susumu Tao (S.T), Shinsuke Miyazaki (S.M), Yoshihide Takahashi (Y.T), Masahiko Goya (M.G), Tetsuo Sasano (T.S), and M.T, and T.I.

・Analysis and interpretation of data: T.I, M.T, and M.G.

・Drafting of the article: T.I, M.T, and Claire Martin (C.M.)

・Revising the article critically for important intellectual content: T.I, M.T, C.M, M.G, S.M, and T.S

All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Masateru Takigawa.

Ethics declarations

Research involving human participants and/or animals

The study was approved by the Ethics Review Board of Tokyo medical and dental university hospital.

Informed consent

All patients provided written informed consent.

Conflict of interest

Dr. Martin and Dr. Miyazaki have received consulting fees from Boston Scientific.

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Ikenouchi, T., Takigawa, M., Goya, M. et al. Requirement of larger local impedance reduction for successful lesion formation at carinal area during pulmonary vein isolation. J Interv Card Electrophysiol 65, 509–518 (2022). https://doi.org/10.1007/s10840-022-01282-1

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  • DOI: https://doi.org/10.1007/s10840-022-01282-1

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