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

Sasaki, Takehito; Nakamura, Kohki; Inoue, Mitsuho; Minami, Kentaro; Miki, Yuko; Goto, Koji; Take, Yutaka; Kaseno, Kenichi; Yamashita, Eiji; Koyama, Keiko; Naito, Shigeto

doi:10.1002/joa3.12403

Cited by 15 publications

(23 citation statements)

References 22 publications

(57 reference statements)

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“…Actually, the initial LI tended to be higher and LI drops tended to be greater in the current study than our previous study with a CTI-RFCA using the former LI-monitoring ablation catheter. 13 During the CTI-RFCA in the current study, the effective ablation sites exhibited a significantly higher initial LI and greater LI drop than the ineffective ablation sites. In an experimental study using the IntellaNav StablePoint catheter by Garrott et al, the LI drop strongly correlated with the lesion depth.…”

Section: Cf and LI Monitoring During Rfcamentioning

confidence: 53%

“…8 Local impedance (LI) monitoring during RFCA has been reported to be useful for predicting an effective ablation, 9,10 and greater LI drops are associated with an effective lesion formation. [11][12][13] In those previous studies with LI monitoring during RFCA, the LI values were measured using a 4-electrode method with micro-electrodes on the 4.5-mm tip of the ablation catheter (IntellaNav MiFi OI, Boston Scientific). On the other hand, a newer ablation catheter capable of LI monitoring (IntellaNav StablePoint; Boston Scientific), which has been recently introduced to clinical practice, uses a 3-electrode method without micro-electrodes to measure the LI values and has a 4-mm catheter tip.…”

Section: Introductionmentioning

confidence: 99%

“…Local impedance (LI) monitoring during RFCA has been reported to be useful for predicting an effective ablation, 9,10 and greater LI drops are associated with an effective lesion formation 11–13 . In those previous studies with LI monitoring during RFCA, the LI values were measured using a 4‐electrode method with micro‐electrodes on the 4.5‐mm tip of the ablation catheter (IntellaNav MiFi OI, Boston Scientific).…”

Section: Introductionmentioning

confidence: 99%

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Local impedance measurements during contact force‐guided cavotricuspid isthmus ablation for predicting an effective radiofrequency ablation

Sasaki

Nakamura

Minami

et al. 2022

Journal of Arrhythmia

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Background An ablation catheter capable of contact force (CF) and local impedance (LI) monitoring (IntellaNav StablePoint, Boston Scientific) has been recently launched. We evaluated the relationship between the CF and LI values during radiofrequency catheter ablation (RFCA) along the cavotricuspid isthmus (CTI). Methods Fifty consecutive subjects who underwent a CTI‐RFCA using IntellaNav StablePoint catheters were retrospectively studied. The initial CF and LI at the start of the RF applications and mean CF and minimum LI during the RF applications were measured. The absolute and percentage LI drops were calculated as the difference between the initial and minimum LIs and 100 × absolute LI drop/initial LI, respectively. Results We analyzed 602 first‐pass RF applications. A weak correlation was observed between the initial CF and LI (r = 0.13) and between the mean CF and LI drops (r = 0.22). The initial LI and absolute and percentage LI drops were greater at effective ablation sites than ineffective ablation sites (median, 151 vs. 138 Ω, 22 vs. 14 Ω, and 14.4% vs. 9.9%; p < .001), but the initial and mean CF did not differ. At optimal cutoffs of 21 Ω and 10.8% for the absolute and percentage LI drops according to the receiver‐operating characteristic analysis, the sensitivity, and specificity for predicting an effective ablation were 57.4% and 88.9% and 80.0%, and 61.1%, respectively. Conclusions The effective sites during the CF‐guided CTI‐RFCA had greater initial LI and LI drops than the ineffective sites. Absolute and percentage LI drops of 21 Ω and 10.8% may be appropriate targets for an effective ablation.

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Section: Cf and LI Monitoring During Rfcamentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Local impedance measurements during contact force‐guided cavotricuspid isthmus ablation for predicting an effective radiofrequency ablation

Sasaki

Nakamura

Minami

et al. 2022

Journal of Arrhythmia

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“…Many technologies are being studied to monitor lesion formation and assess lesion transmurality. For example, a novel ablation catheter has been developed to estimate lesion formation based on local impedance change 12 – 15 , and has been combined with CF to improve lesion prediction 16 . Though, more studies are needed to investigate the effectiveness of this technique.…”

Section: Introductionmentioning

confidence: 99%

Polarization-sensitive optical coherence tomography monitoring of percutaneous radiofrequency ablation in left atrium of living swine

Zhao

Ziv

Mohammadpour

et al. 2021

Sci Rep

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Radiofrequency ablation (RFA) is commonly used to treat atrial fibrillation (AF). However, the outcome is often compromised due to the lack of direct real-time feedback to assess lesion transmurality. In this work, we evaluated the ability of polarization-sensitive optical coherence tomography (PSOCT) to measure cardiac wall thickness and assess RF lesion transmurality during left atrium (LA) RFA procedures. Quantitative transmural lesion criteria using PSOCT images were determined ex vivo using an integrated PSOCT-RFA catheter and fresh swine hearts. LA wall thickness of living swine was measured with PSOCT and validated with a micrometer after harvesting the heart. A total of 38 point lesions were created in the LA of 5 living swine with the integrated PSOCT-RFA catheter using standard clinical RFA procedures. For all lesions with analyzable PSOCT images, lesion transmurality was assessed with a sensitivity of 89% (17 of 19 tested positive) and a specificity of 100% (5 of 5 tested negative) using the quantitative transmural criteria. This is the first report of using PSOCT to assess LA RFA lesion transmurality in vivo. The results indicate that PSOCT may potentially provide direct real-time feedback for LA wall thickness and lesion transmurality.

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“…Atrial fibrillation (AF) and cavo-tricuspid isthmus (CTI)-dependent (typical) atrial flutter (AFL) often coexist and catheter ablation has been an established treatment strategy for those arrhythmias. [1][2][3] The widely accepted indication (Class 1 indication) of creating linear block across the CTI is clinically documented AFL and inducible AFL at the time of the ablation procedure, 1 and the evidence supporting an empiric CTI ablation during an AF ablation procedure is limited.…”

Section: Introductionmentioning

confidence: 99%

Safety and durability of cavo‐tricuspid isthmus linear ablation in the current era: Single‐center 9‐year experience from 1078 procedures

Kakehashi

Miyazaki

Hasegawa

et al. 2021

Cardiovasc electrophysiol

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Background: Cavo-tricuspid isthmus (CTI) linear ablation is performed not only for atrial flutter (AFL) but empirically during atrial fibrillation (AF) ablation in real-world practice.Purpose: We sought to evaluate the safety and durability of the CTI ablation.Methods: This retrospective study included 1078 consecutive patients who underwent a CTI ablation. AFL was documented before or during the procedure in 249 (23.1%) patients, and an empirical CTI and AF ablation were performed in 829 (76.9%) patients.Results: CTI block was successfully created in 1051 (97.5%) patients with a 10.3 ± 6.6 min total radiofrequency time. Repeat procedures were performed for recurrent arrhythmias in 187 (17.3%) patients at a median of 11.0 (5.0-30.0) months postprocedure, and conduction resumption was identified in 68/174 (39.1%).Among those undergoing a CTI ablation with an AF ablation, the durability was significantly higher in those with than without documented AFL (78.1% vs. 58.2%, p = .031). The total radiofrequency time was significantly shorter (9.0 ± 5.3 vs. 10.0 ± 6.4 [mins], p = .024) and durability significantly higher (78.1 vs. 58.7[%], p = .043) in the large-tip than irrigated-tip catheter group. Iatrogenic AFL was observed after the empiric CTI ablation in 11 (1.3%) patients. Procedure-related complications occurred in 15 (1.4%) patients. Eight patients experienced coronary artery spasms, including one with ventricular fibrillation following ST elevation on the ward. The other six patients experienced transient atrioventricular block and one experienced cardiac tamponade requiring drainage.Conclusions: Despite a high acute CTI ablation success, the conduction block durability was relatively low after the empiric ablation. An empiric CTI ablation at the time of the AF ablation is not recommended.

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

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 15 publications

References 22 publications

Local impedance measurements during contact force‐guided cavotricuspid isthmus ablation for predicting an effective radiofrequency ablation

Local impedance measurements during contact force‐guided cavotricuspid isthmus ablation for predicting an effective radiofrequency ablation

Polarization-sensitive optical coherence tomography monitoring of percutaneous radiofrequency ablation in left atrium of living swine

Safety and durability of cavo‐tricuspid isthmus linear ablation in the current era: Single‐center 9‐year experience from 1078 procedures

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