Changes in Local Wall Thickness Correlate with Pathologic Lesion Size Following Radiofrequency Catheter Ablation: An Intracardiac Echocardiographic Imaging Study

Background: Local impedance (LI) can indirectly measure catheter contact and tissue temperature during radiofrequency catheter ablation (RFCA). However, data on the effects of catheter contact angle on LI parameters are scarce. This study aimed to evaluate the influence of catheter contact angle on LI changes and lesion size with 2 different LI-sensing catheters in a porcine experimental study. Methods: Lesions were created by the INTELLANAV MiFi™ OI (MiFi) and the INTELLANAV STABLEPOINT™ (STABLEPOINT). RFCA was performed with 30 watts and a duration of 30 seconds. The CF (0, 5, 10, 20, and 30 g) and catheter contact angle (30°, 45°, and 90°) were changed in each set (n=8 each). The LI rise, LI drop, and lesion size were evaluated. Results: The LI rise increased as CF increased. There was no angular dependence with the LI rise under all CFs in the MiFi. On the other hand, the LI rise at 90° was lower than at 30° under 5 and 10 g of CF in STABLEPOINT. The LI drop increased as CF increased. Regarding the difference in catheter contact angles, the LI drop at 90° was lower than that at 30° for both catheters. The maximum lesion widths and surface widths were smaller at 90° than at 30°, whereas there were no differences in lesion depths. Conclusion: The LI drop and lesion widths at 90° were significantly smaller than those at 30°, although the lesion depths were not different among the 3 angles for the MiFi and STABLEPOINT.

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Determinants of Lesion Size During Radiofrequency Catheter Ablation: The Role of Electrode-Tissue Contact Pressure and Duration of Energy Delivery

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.1991.tb01353.x ◽

1991 ◽

Vol 2 (6) ◽

pp. 509-515 ◽

Cited By ~ 166

Author(s):

DAVID E. HAINES

Keyword(s):

Catheter Ablation ◽

Contact Pressure ◽

Radiofrequency Catheter Ablation ◽

Lesion Size ◽

Energy Delivery

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Use of the Saline Infusion Electrode Catheter for Improved Energy Delivery and Increased Lesion Size in Radiofrequency Catheter Ablation

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.1995.tb04743.x ◽

1995 ◽

Vol 18 (5) ◽

pp. 1022-1027 ◽

Cited By ~ 37

Author(s):

ROBERT S. MITTLEMAN ◽

SHOEI K. STEPHEN HUANG ◽

WILSON GUZMAN ◽

HENRI CUENOUD ◽

ALAN B. WAGSHAL ◽

...

Keyword(s):

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Lesion Size ◽

Saline Infusion ◽

Energy Delivery

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Catheter contact angle influences local impedance drop during radiofrequency catheter ablation: insight from a porcine experimental study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0362 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

G Matsuura ◽

H Fukaya ◽

E Ogawa ◽

S Kawakami ◽

D Saito ◽

...

Keyword(s):

Experimental Study ◽

Contact Angle ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Lesion Size ◽

Contact Angles ◽

Tissue Temperature ◽

Ablation Catheter ◽

Lesion Depth ◽

The Difference

Abstract Background Local impedance (LI) at a distal tip of the ablation catheter can indirectly measure catheter contact and tissue temperature during radiofrequency catheter ablation (RFCA). LI decreases by RFCA, and a degree of LI drop is correlated with lesion size. However, data on the effects of catheter contact angle on lesion size and LI drop were scarce. This study aimed to evaluate the influence of catheter contact angle on lesion size and LI drop in a porcine experimental study. Methods Lesions were created on porcine myocardial left ventricles by the LI-sensing ablation catheter (IntellaNav MiFi OI®). Contact force (CF) was measured using pressure to current transducer (load cell). Radiofrequency ablation was performed with a power of 30 Watt and a duration of 30 seconds. CF (0g, 5g, 10g, 20g, and 30g) and catheter angle (30°, 45°, and 90°) were changed in each set (total 120 lesions, n=8 each). LI rise, LI drop by RF application, and lesion size (maximum lesion width, maximum surface width, and maximum lesion depth) were evaluated. Results There was no angular dependence in LI rise in all CF. The values of LI rise increased as CF increased. The LI drop also increased as CF increased in all contact angles. Regarding the difference of catheter angles, LI drop with 90° was lower than those with 30° and 45°in CF 10g, 20g, and 30g, respectively. Maximum lesion width and surface width were larger in 30° and 45° than those in 90°, whereas there were no differences in maximum lesion depth. Conclusion LI drop in 90° were significantly lower than those in 45° and 30°. Although lesion depths were not different among the three angles, the absolute values of LI drop were different. Caution should be exercised to comprehend the LI drop with catheter angles. FUNDunding Acknowledgement Type of funding sources: None.

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Association between ablation index and myocardial injury following radiofrequency catheter ablation for atrial fibrillation

EP Europace ◽

10.1093/europace/euab116.218 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

A De Bortoli ◽

O-G Anfinsen ◽

T Holm

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Myocardial Injury ◽

Troponin T ◽

Lesion Size ◽

Limiting Factor ◽

Af Ablation ◽

Ablation Index ◽

Target Values

Abstract Funding Acknowledgements Type of funding sources: None. Background Unpredictable lesion formation is a major limiting factor for radiofrequency catheter ablation for atrial fibrillation (AF). Ablation index (AI) emerged as a novel parameter to monitor lesion development and potentially improve clinical outcomes. Additional evidence is needed to support its use. Purpose We aimed at evaluating the relationship between AI and other lesion indicators and the release of myocardial-specific biomarkers following AF ablation. Methods Forty-six patients with similar baseline characteristics underwent a first-time radiofrequency ablation for AF and were prospectively enrolled in this study. Pulmonary vein isolation was performed by six experienced electrophysiologists with a point-by-point approach, guided by strict Visitag criteria and consistent AI target values. Myocardial-specific biomarkers troponin T and creatine kinase myocardial band were measured after 6 (TnT6 and CKMB6) and 20 hours (TnT20 and CKMB20) following sheath removal. Ablation duration, impedance drop (ID), force-time integral (FTI) and AI were registered automatically and analyzed off-line. Since biomarkers release reflect the total amount of myocardial injury, our independent variables consisted of total ablation duration, total ID, total FTI and total AI. Results 97% of total ablation duration fulfilled pre-specified Visitag criteria. Mean application duration was 20.0 ± 3.5 s, mean contact force was 15.9 ± 4.2 g, mean maximum power was 35.3 ± 1.5 W. Troponin T release was 985 ± 495 ng/L and 1038 ± 461 ng/L (p = ns) while CKMB release was 7.3 ± 2.7 mcg/L and 6.5 ± 2.1 mcg/L (p < 0.001) at 6 and 20 hours, respectively. Ablation duration, ID, FTI and AI were all significantly correlated with the release of myocardial-specific biomarkers both at 6 and 20 hours (all correlations significant at p < 0.01 level, Fig. 1). Ablation index showed the highest degree of correlation with TnT6, TnT20, CKMB6 and CKMB20 (Pearson`s R 0.69, 0.69, 0.58, 0.64 respectively, p < 0.001). Multiple regression analysis demonstrated that AI had the strongest association with TnT6, TnT20, CKMB6 and CKMB20 (beta 0.43, 0.71, 0.41 and 0.43, respectively). Conclusion Ablation index appears as the strongest lesion size indicator as measured by the release of myocardial-specific biomarkers following radiofrequency catheter ablation for AF. Abstract Figure. Scatter plots and correlations

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Lesion Size and Lesion Maturation After Radiofrequency Catheter Ablation for Ventricular Tachycardia in Humans With Nonischemic Cardiomyopathy

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.121.009808 ◽

2021 ◽

Author(s):

Claire A. Glashan ◽

William Stevenson ◽

Katja Zeppenfeld

Keyword(s):

Ventricular Tachycardia ◽

Catheter Ablation ◽

Radiofrequency Catheter Ablation ◽

Lesion Size ◽

Nonischemic Cardiomyopathy

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Abstract 14782: Incidence and Characteristics of Pulmonary Vein Stenosis Following Catheter Ablation of Atrial Fibrillation: Insights From the Contemporary Multicenter ADVICE Trial

Circulation ◽

10.1161/circ.130.suppl_2.14782 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Sophie Gomes ◽

Paul Khairy ◽

Jason Andrade ◽

Stanley Nattel ◽

Mario Talajic ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Confidence Interval ◽

Pulmonary Vein ◽

Radiofrequency Catheter Ablation ◽

Imaging Study ◽

Heart Rhythm ◽

Systematic Evaluation ◽

Pulmonary Vein Stenosis ◽

Luminal Diameter

Introduction: Pulmonary vein (PV) stenosis is a well-described complication of atrial fibrillation (AF) ablation. Available data regarding the incidence of pulmonary vein (PV) stenosis associated with radiofrequency catheter ablation of AF are limited to surveys, single-center studies, and small trials. We prospectively assessed the incidence of PV stenosis after catheter ablation of AF in the context of a large randomized multicenter international study (ADVICE). Methods: Patients undergoing a first PV isolation procedure for the treatment of symptomatic paroxysmal AF were enrolled from 13 centers. PV isolation was performed by encircling all PVs using an irrigated-tip radiofrequency ablation catheter guided by a circular mapping catheter with the endpoint of electrical PV isolation. Systematic imaging of the left atrium and PVs using computed tomography-scan (CT-Scan) or magnetic resonance (MRI) was performed at 90 days post ablation to assess the incidence of PV stenosis. Significant PV stenosis was defined by a narrowing of PV luminal diameter greater than 70% as per Heart Rhythm Society guidelines. The incidence of moderate PV stenosis defined by a narrowing between 50% and 70% was also analyzed. Predictors of PV stenosis were explored by logistic regression analyses. Results: A total of 197 patients (mean age 59±9 yrs, 71% male) were included in this study. Electrical PV isolation was achieved in all patients. On the post ablation imaging study (performed at a mean of 103±33 days post ablation), a significant PV stenosis was observed in 1.52% [95% confidence interval (0.00%-3.23%)] of patients. In addition, a moderate PV stenosis was seen in 3.55% [95% confidence interval (0.97%-6.14%)] of patients. The affected PVs included 8 left inferior PVs, 1 right inferior and 1 right middle PV. None of the patients were symptomatic or required an intervention related to the PV stenosis. The presence of PV stenosis could not be predicted by clinical, hemodynamic, or procedural parameters. Conclusions: Our systematic evaluation of the incidence of PV stenosis in the context of a prospective multinational trial confirms previously reported low rates of significant PV stenosis following radiofrequency catheter ablation of AF.

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