Assessment of the transmural unipolar electrogram morphology change radius during contact force-guided pulmonary vein isolation using the VISITAG™ Module and CARTOREPLAY™

Tomlinson, David R.; Stevens, Kara; Streeter, Adam

doi:10.1101/284539

Cited by 3 publications

(3 citation statements)

References 27 publications

(34 reference statements)

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“…Thermodynamic laws require the possibility of clinically important tissue heating beyond the immediate location of a 3-mm-radius auto-annotated ablation site. 19,20 Therefore, when closely spaced consecutive RF applications occur over short inter-ablation site times, deep RF effects resulting from higher starting tissue temperatures at subsequently targeted sites may be excessive, risking later AEF formation. Presently, auto-annotation-guided protocols for RF delivery fail to account for this factor.…”

Section: Randomizedmentioning

confidence: 99%

Radiofrequency ablation data associated with atrioesophageal fistula

Tomlinson

Mandrola

2021

HeartRhythm Case Reports

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Section: Randomizedmentioning

confidence: 99%

Radiofrequency ablation data associated with atrioesophageal fistula

Tomlinson

Mandrola

2021

HeartRhythm Case Reports

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“…Finally, achieving durable PVI requires sufficient overlap of TM RF effect between adjacent lesions; these present data provide no information concerning the diameter of TM ablative effects. However, through conducting similar investigations to those described here, the diameter of RF‐induced thermal injury may be identified during PVI; these data are presented in a prepublication report online …”

Section: Discussionmentioning

confidence: 86%

Transmural unipolar electrogram change occurs within 7 s at the left atrial posterior wall during pulmonary vein isolation

Tomlinson

Myles

Stevens

et al. 2019

Pacing Clinical Electrophis

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Background: To assess occurrence of a histologically validated measure of transmural (TM) atrial ablation-pure R unipolar electrogram (UE) morphology change-at first-ablated left atrial posterior wall (LAPW) sites during contact force (CF)-guided pulmonary vein isolation (PVI). Methods: Objectively annotated VISITAG TM Module and CARTOREPLAY TM (Biosense Webster Inc., Diamond Bar, CA, USA) UE morphology data were retrospectively analyzed in 23 consecutive patients undergoing PVI under general anesthesia. Results: PVI without spontaneous/dormant recovery was achieved in all, employing 16.3 (3.2) min of radiofrequency (RF; 30 W) energy. All first-ablated LAPW sites demonstrated RS UE morphology preablation, with RF-induced pure R UE morphology change in 98%. Time to pure R UE morphology was significantly shorter at left-sided LAPW sites (4.9 [2.1] vs 6.7 [2.5] s; P = .02), with significantly greater impedance drop (median 13.5 vs 9.9 Ω; P = .003). Importantly, neither firstsite RF duration (14.9 vs 15.0 s) nor maximum ablation catheter tip distance moved (during RF) was significantly different, yet the mean CF was significantly higher at right-sided sites (16.5 vs 11.2 g; P = .002). Concurrent impedance and objectively annotated bipolar electrogram (BE) data demonstrated ∼6-8 Ω impedance drop and ∼30% BE decrease at the time of first pure R UE morphology change. Conclusions: Using objective ablation site annotation, UE morphology evidence of TM RF effect was demonstrated far sooner than considered biologically possible according to the "conventional" 20-40 s RF per-site approach, with significantly greater ablative effect evident at left-sided sites. This novel methodology represents a scientifically more rigorous foundation toward future research into the biological effects of RF ablation in vivo. K E Y W O R D S atrial fibrillation, contact force catheter ablation, pulmonary vein isolation, unipolar electrogram, VISITAG TM Module 1 922

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“…">inter‐ablation site transition during constant catheter‐tissue contact, with pure R UE morphology at both site‐1 completion and site‐2 onset (i.e. within the thermal penumbra of partial ablation effect 9 ).…”

Section: Methodsmentioning

confidence: 99%

Identification of deliberate catheter motion at the left atrial posterior wall during pulmonary vein isolation: Validity of respiratory motion adjustment

Tomlinson

Biscombe

True

et al. 2021

Cardiovasc electrophysiol

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Background During automated radiofrequency (RF) annotation‐guided pulmonary vein isolation (PVI), respiratory motion adjustment (RMA) is recommended, yet lacks in vivo validation. Methods Following contact force (CF) PVI (continuous RF, 30 W) using general anesthesia and automated RF annotation‐guidance (VISITAG™: force‐over‐time 100% minimum 1 g; 2 mm position stability; ACCURESP™ RMA “off”) in 25 patients, we retrospectively examined RMA settings “on” versus “off” at the left atrial posterior wall (LAPW). Results Respiratory motion detection occurred in eight, permitting offline retrospective comparison of RMA settings. Significant differences in LAPW RF auto‐annotation occurred according to RMA setting, with curves displaying catheter position, CF and impedance data indicating “best‐fit” for catheter motion detection using RMA “off.” Comparing RMA “on” versus “off,” respectively: total annotated sites, 82 versus 98; median RF duration per‐site, 13.3 versus 10.6 s (p < 0.0001); median force time integral 177 versus 130 gs (p = 0.0002); mean inter‐tag distance (ITD), 6.0 versus 4.8 mm (p = 0.002). Considering LAPW annotated site 1‐to‐2 transitions resulting from deliberate catheter movement, 3 concurrent with inadvertent 0 g CF demonstrated < 0.6 s difference in RF duration. However, 13 deliberate catheter movements during constant tissue contact (ITD range: 2.1–7.0 mm) demonstrated (mean) site‐1 RF duration difference 3.7 s (range: −1.3 to 11.3 s): considering multiple measures of catheter position instability, the appropriate indication of deliberate catheter motion occurred with RMA “off” in all. Conclusions ACCURESP™ respiratory motion adjustment importantly delayed the identification of deliberate and clinically relevant catheter motion during LAPW RF delivery, rendering auto‐annotated RF display invalid. Operators seeking greater accuracy during auto‐annotated RF delivery should avoid RMA use.

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Assessment of the transmural unipolar electrogram morphology change radius during contact force-guided pulmonary vein isolation using the VISITAG™ Module and CARTOREPLAY™

Cited by 3 publications

References 27 publications

Radiofrequency ablation data associated with atrioesophageal fistula

Radiofrequency ablation data associated with atrioesophageal fistula

Transmural unipolar electrogram change occurs within 7 s at the left atrial posterior wall during pulmonary vein isolation

Identification of deliberate catheter motion at the left atrial posterior wall during pulmonary vein isolation: Validity of respiratory motion adjustment

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