Radiofrequency catheter ablation of atrial fibrillation: Electrical modification suggesting transmurality is faster achieved with remote magnetic catheter in comparison with contact force use

Abstract

Remote magnetic AF ablation is associated with faster EGM modification suggesting transmurality than optimized CF and FTI-guided catheter ablation.

Single transseptal puncture technique and contact force catheter: A simplified ablation strategy for paroxysmal atrial fibrillation

“…Procedures have been shortened due to faster assessment of appropriate catheter contact, resulting in the reduction of radiation (14,(19)(20)(21). In CF-guided PV isolation, pulmonary vein reconnection remains primarily attributable to insufficient lesion depth and contiguity (17). Additionally, since the achievement of ideal ablation lesions depends on a combination of CF, power and duration parameters, the integration of these parameters via an automated algorithm, such as the Visitag with Ablation Index, may provide a valuable solution to this complex optimization problem (22)(23)(24).…”

“…CF-guided catheters can provide stable and moderate CF, allowing for improvements in ablation safety and effectiveness, while simultaneously reducing procedure and fluoroscopy times ( 16 ). The improved catheter stability leads to faster transmural lesion formation ( 17 ), particularly in the right side PV ( 18 ). Procedures have been shortened due to faster assessment of appropriate catheter contact, resulting in the reduction of radiation ( 14 , 19-21 ).…”

A comparison of contact force and remote magnetic navigation on lesion formation for the ablation of atrial fibrillation

“…Although in clinical studies, a reduction in EGM amplitude of ≥80% has often been considered an optimal target to achieve transmurality, other data show efficacy at lower levels of signal reduction, typically approximately 60% . Morphology changes in sinus rhythm EGMs occur together with voltage reduction in the case of bipolar signals as a consequence of local changes in activation and alterations in myocardial properties . Therefore, RF‐related morphologic variation of the bipolar signal may impact peak‐to‐peak voltage reduction, which cannot be considered a reliable sign of a transmural lesion.…”

Remote magnetic navigation versus contact force technology: The two faces of the ablation lesion

“…The creation of transmural lesions is a goal of catheter ablation with the aim of generating a long‐lasting barrier to electrical conduction and the removal of electrical triggers translating into a reduction in arrhythmia recurrence. While earlier suggestions that CF would produce more transmural lesions, recent data suggest a similar ability between CF and RMN to produce transmurality . In fact, there appears to be a threshold in terms of signal attenuation that denotes a transmural lesion.…”

“…Using unipolar voltage, the reductions were 74% and 68%, respectively. In a study assessing the occurrence of transmural lesion using signal attenuation and impedance drops, RMN‐guided ablation achieved transmurality criteria faster (less RF applications) than CF‐guided ablation …”