Different Patterns of the Fall of Impedance as the Result of Heating During Ostial Pulmonary Vein Ablation: Implications for Power Titration

Reithmann, Christopher; Remp, T.; Hoffmann, Ellen; Matis, Tomas; Wakili, Reza; Steinbeck, Gerhard

doi:10.1111/j.1540-8159.2005.00269.x

Cited by 22 publications

(34 citation statements)

References 48 publications

(50 reference statements)

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“…Strickberger and colleagues 10 correlated impedance drop with catheter electrode temperature and the presence of thrombus on the catheter in 33 patients undergoing RF ablation of accessory pathways with a 4‐mm tip thermistor tipped catheter. They found that an impedance drop of 5–10 Ω appeared optimal (effective tissue heating and low rate of thrombus), whereas RF applications that were associated with thrombus formation had a mean impedance drop of 19 Ω. Reithmann and colleagues 7 investigated the use of impedance‐controlled ablation using a 4‐mm tip ablation catheter in 70 patients undergoing pulmonary vein isolation procedures. Power was titrated to achieve an impedance drop of 20 Ω with a low rate of impedance rises (0.3%).…”

Section: Discussionmentioning

confidence: 99%

“…The impedance fall that occurs during RF ablation has been postulated to be caused by an increase in tissue temperature, 7,8,10,12 but some authors have detected irreversible changes in components of the impedance 11 . Data recorded during repeated ablations at the same site suggested that the impedance drop occurring during radiofrequency ablation in cardiac tissue appeared to be due to reversible factors (e.g., temperature) rather than irreversible changes.…”

Section: Discussionmentioning

confidence: 99%

“…The safety and efficacy profile of fixed power 3 and temperature control 4,5 during irrigated‐tip catheter ablation have been investigated previously. Titration of RF power using the drop‐in impedance during ablation has been proposed as an alternative strategy to temperature‐controlled or fixed‐power ablation protocols 6–8 . The impedance drop during radiofrequency (RF) ablation has been postulated to be secondary to increased myocardial tissue temperature 7,9,10 .…”

Section: Introductionmentioning

confidence: 99%

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Impedance and Temperature Monitoring Improve the Safety of Closed‐Loop Irrigated‐Tip Radiofrequency Ablation

Thiagalingam

d’Ávila

McPherson

et al. 2007

Cardiovasc electrophysiol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impedance and Temperature Monitoring Improve the Safety of Closed‐Loop Irrigated‐Tip Radiofrequency Ablation

Thiagalingam

d’Ávila

McPherson

et al. 2007

Cardiovasc electrophysiol

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“…12,13 Prior clinical and experimental studies have found an impedance decrease from baselines of at least 5 O to 10 O to be best associated with effective tissue destruction, regardless of the baseline tissue characteristics. 12,14,15 Impedance monitoring can also guide the duration of lesion application, as lesion expansion may continue for 10 s following reaching the plateau of the impedance curve. 16 Additionally, impedance monitoring has an additional important role for monitoring safety of RF energy application, as steam pops are rarely seen when the impedance decrease is less than 15 ohms (O).…”

Section: Rf Lesion Assessmentmentioning

confidence: 99%

Impedance-guided Radiofrequency Ablation: Using Impedance to Improve Ablation Outcomes

Chinitz

Michaud

Stephenson

2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. Despite the achievement of acute conduction block during catheter ablation, the recovery of conduction at previously ablated sites remains a primary factor implicated in arrhythmia recurrence after initial ablation. Real-time markers of adequate ablation lesion creation are needed to ensure durable ablation success. However, the assessment of acute lesion formation is challenging, and requires interpretation of surrogate markers of lesion creation that are frequently unreliable. Careful monitoring of impedance changes during radiofrequency catheter ablation has emerged as a highly specific marker of local tissue destruction. Ablation strategies guided by close impedance monitoring during ablation applications have been demonstrated to achieve high levels of success for ablation of atrial fibrillation. Impedance decrease during ablation may therefore be used as an additional endpoint beyond acute conduction block, in order to improve the durability of ablation lesions. In this manuscript, available methods of real-time lesion assessment are reviewed, and the rationale and technique for impedance-guided ablation are described.

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“…8 A linearly increasing fall in impedance with an increasing catheter tip temperature has been described for nonirrigated ablation. 4,9,10 This has been suggested to be because of increased conductivity of cardiac tissue with heating.…”

Section: Discussionmentioning

confidence: 99%

Target Indices for Clinical Ablation in Atrial Fibrillation

Ullah

Hunter

Baker

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-In animal studies of radiofrequency ablation, lesion sizes plateau as the maximum lesion size is reached for an ablation. Lesion parameters are not available in clinical ablations, but preclinical work suggests that these correlate with impedance drop and electrogram attenuation. Characterization of the relationships between catheter contact force, ablation duration, and these surrogate markers of lesion formation may allow us to define targets for effective ablation. Methods and Results-Fifteen patients undergoing first-time radiofrequency ablation for nonparoxysmal atrial fibrillation were studied. All were in atrial fibrillation at the time of the procedure. Ablations were performed with an irrigated-tip contact force-sensing catheter in temperature-controlled mode (temperature limited to 48°C, power to 30 W). Included were 285 left atrial static ablations, 247 with additional impedance data. The ablation force time integral (FTI) correlated with the attenuation of the electrogram with ablation (Spearman ρ, -0.14; P=0.02): the relationship plateauing from 500 g·s, a reduction in the electrogram amplitude of 20%. The FTI also correlated with the impedance drop during ablation (Spearman ρ, 0.79; P<0.0005): the relationship was logarithmic, the reduction in the impedance with an increasing FTI also plateauing from 500 g·s, an impedance drop of 7.5%. The ablation duration affected the impedance drop at an FTI if the duration was <10 s. Beyond this time point, the FTI achieved rather than the ablation duration or mean contact force applied determined the impedance drop. Conclusions-During nonparoxysmal atrial fibrillation ablation, an FTI of 500 g·s should be targeted with ablation duration of ≥10 s. Clinical Trials Registration-URL: http://clinicaltrials.gov/. Unique Identifier: NCT01587404.(Circ Arrhythm Electrophysiol. 2014;7:63-68.)

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Different Patterns of the Fall of Impedance as the Result of Heating During Ostial Pulmonary Vein Ablation: Implications for Power Titration

Cited by 22 publications

References 48 publications

Impedance and Temperature Monitoring Improve the Safety of Closed‐Loop Irrigated‐Tip Radiofrequency Ablation

Impedance and Temperature Monitoring Improve the Safety of Closed‐Loop Irrigated‐Tip Radiofrequency Ablation

Impedance-guided Radiofrequency Ablation: Using Impedance to Improve Ablation Outcomes

Target Indices for Clinical Ablation in Atrial Fibrillation

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