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

Abstract

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.

Ablation Index‐guided point‐by‐point ablation versus Grid annotation‐guided dragging for pulmonary vein isolation: A randomized controlled trial

“…A recent study showed that identification of catheter motion may be delayed with use of respiratory motion adjustment, which may lead to inaccurate ablation annotation. 20 The majority of procedures in this study were performed under deep sedation (with maintenance of spontaneous breathing), which may result in less predictable respiratory movement compared with general anesthesia. Use of general anesthesia may improve catheter stability and ablation annotation, and may improve clinical outcomes.…”