A novel assessment of local impedance during catheter ablation: initial experience in humans comparing local and generator measurements

Gunawardene, Melanie; Münkler, Paula; Eickholt, Christian; Akbulak, Ruken Ö.; Jularic, Mario; Klatt, Niklas; Hartmann, Jens; Dinshaw, Leon; Jungen, Christiane; Moser, Julia; Merbold, Lydia; Willems, Stephan; Meyer, Christian

doi:10.1093/europace/euy273

Cited by 52 publications

(98 citation statements)

References 19 publications

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“…Local impedance may indicate the local voltage and scarring 11 . Interestingly, in our study, the localization of the conduction gaps after index CF‐RFC or CB PVI showed no difference in baseline local impedance values.…”

Section: Discussionmentioning

confidence: 41%

“…All patients underwent a reablation procedure using UHDx mapping. UHDx mapping was performed, as previously described 11,12 . After transseptal puncture using a modified Brockenbrough technique to access the left atrium (LA), a long sheath (SL0, 8 F; St Jude) as well as a steerable sheath (ZURPAZ, 8.5 F; Boston Scientific, Marlborough, MA) were navigated into the LA.…”

Section: Methodsmentioning

confidence: 99%

“…Local impedance (LI) was measured by an open‐irrigated single‐tip mapping and ablation catheter (IntellaNav MiFi OI; Boston Scientific). The technical aspects of this approach have been described before 11 . At the beginning of RFC delivery, baseline LI and baseline generator impedance (GI) using an RFC generator (EP Shuttle; Stockert, Biosense Webster Inc, Diamond Bar, CA) were analyzed, as well as LI and GI drops and the time until the impedance drop during RFC ablation.…”

Section: Methodsmentioning

confidence: 99%

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Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current

Gunawardene

Akbulak

Jularic

et al. 2020

Cardiovasc electrophysiol

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Introduction:The aim of this study was to investigate electrophysiological findings in patients with arrhythmia recurrence undergoing a repeat ablation procedure using ultra-high-density (UHDx) mapping following an index procedure using either contact-force (CF)-guided radiofrequency current (RFC) pulmonary vein isolation (PVI) or second-generation cryoballoon (CB) PVI for treatment of atrial fibrillation (AF). Methods and Results: Fifty consecutive patients with recurrence of AF and/or atrial tachycardia (AT) following index CF-RFC PVI (n = 21) or CB PVI (n = 29) were included. A 64-pole mini-basket mapping catheter in combination with an UHDxmapping system-guided ablation was used. RFC was applied using a catheter tip with three incorporated mini-electrodes. PV reconnection rates were higher after CF-RFC PVI (CF-RFC: 2.5 ± 1.3 PVs vs CB: 1.4 ± 0.9 PVs; P = .0025) and left PVs were more frequently reconnected (CF-RFC: 64% PVs vs CB: 35% PVs; P = .0077).Fractionated signals along the antral index ablation line (FS) were found in 30% of CB-PVI patients (CF-RFC: 9.5% vs CB:30%; P = .098) targeted for ablation. In five cases, FS were a critical part of maintaining consecutive AT. The main AT mechanism found during reablation (n = 45 ATs) was macroreentry (80% [36/45], CF-RFC: 78.9% vs CB: 80.8%; P = 1.0) with a variety of circuits throughout both atria.Conclusion: UHDx mapping is sensitive in detecting conduction gaps along the index ablation line. Left PVs are more frequently reconnected after initial CF-RFC PVI. FS are a common finding after CB PVI and can maintain certain forms of ATs. ATs after index PVI are mostly macroreentries with a broad spectrum of entities. K E Y W O R D Satrial fibrillation, contact-force radiofrequency catheter ablation, cryoballoon ablation, pulmonary vein isolation, ultra-high-density mapping

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Section: Discussionmentioning

confidence: 41%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current

Gunawardene

Akbulak

Jularic

et al. 2020

Cardiovasc electrophysiol

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“…Impedance is measured from the minielectrodes with a sampling rate of 20 Hz. The catheter has been described in detail previously …”

Section: Methodsmentioning

confidence: 99%

“…Recently, a novel ablation catheter incorporating three mini‐electrodes in its tip measuring local impedance (LI) at the distal electrode of the catheter has been developed and introduced to clinical practice . Herein, we studied LI in comparison to GI during catheter ablation of ventricular tachycardia (VT) to assess its applicability as a feed‐back‐parameter of RFC‐ablation.…”

Section: Introductionmentioning

confidence: 99%

Local impedance guides catheter ablation in patients with ventricular tachycardia

Münkler

Gunawardene

Jungen

et al. 2019

Cardiovasc electrophysiol

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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 RFCablation. 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 RFCablation 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. K E Y W O R D Scatheter ablation, electrical impedance, high-density mapping, radiofrequency, ventricular tachycardia ---

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Optimal local impedance drops for an effective radiofrequency ablation during cavo‐tricuspid isthmus ablation

Sasaki

Nakamura

Inoue

et al. 2020

Journal of Arrhythmia

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A novel assessment of local impedance during catheter ablation: initial experience in humans comparing local and generator measurements

Cited by 52 publications

References 19 publications

Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current

Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current

Local impedance guides catheter ablation in patients with ventricular tachycardia

Optimal local impedance drops for an effective radiofrequency ablation during cavo‐tricuspid isthmus ablation

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