Elimination of the negative component of the unipolar electrogram as a local procedural endpoint during paroxysmal atrial fibrillation catheter ablation using contact-force sensing: the UNIFORCE study

Abstract

Unipolar atrial signal analysis combined with CF sensing ensures a robust 2-year SR maintenance rate in the treatment of PAF. Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02520960.

Ablation catheter motion detection during contact force and VISITAG™ Module-guided pulmonary vein isolation

“…Combined data analysis demonstrated that annotated distance to site 2 was significantly greater with ACCURESP™ "on" versus "off" (i.e. 6.7mm versus 5.2mm, p=0.02), while the observed difference in site 1 RF duration 12 (15.7s versus 15.1s, p=0.09) and FTI (240g.s versus 198g.s, p=0.38) was not statistically significant.…”

Comparison of high‐power and conventional‐power radiofrequency energy deliveries in pulmonary vein isolation using unipolar signal modification as a local endpoint

“…It has been reported that the USM is a useful guide for the endpoint of each RF application while performing the PVI. [5][6][7]19 In some cases, however, the USM did not translate into damage creation. 20 To create transmural and irreversible (rather than functional and potentially reversible) lesions, extended RF applications for a few seconds after the negative component of the USM are needed.…”

“…4 R morphology achievement, the so-called the unipolar signal modification (USM), has been reported as a useful guide for the endpoint of each RF application and provides a real-time evaluation of the transmural lesion creation while performing the PVI. [5][6][7] During RF ablation, a lesion is created by resistive heating followed by conductive heating. Resistive heating immediately causes irreversible myocardial tissue injury with cellular death, whereas conductive heating passively extends to deeper tissue layers causing potential reversible tissue damage.…”

“…It has been demonstrated in a porcine model that complete elimination of the negative component of the unipolar atrial electrogram (R morphology achievement), while applying RF energy, is always associated with transmural lesions 4 . R morphology achievement, the so‐called the unipolar signal modification (USM), has been reported as a useful guide for the endpoint of each RF application and provides a real‐time evaluation of the transmural lesion creation while performing the PVI 5‐7 …”

‘CLOSE’-Guided Pulmonary Vein Isolation and Changes in Local Bipolar and Unipolar Atrial Electrograms:Observations from the EP Lab

“…Likewise Bortone et al showed in a closed-dog model that elimination of the negative component of the unipolar atrial electrogram reflects, in general, irreversible transmural necrosis creation [5] . Of interest, the same research group described recently a CF-guided ablation strategy in which RF is continued 5 to 15s after elimination of the negative component which apparently was obtained in all applications [21] .…”