scholarly journals Novel simultaneous assessment of contact force and local impedance for radiofrequency catheter ablation guidance

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
FA Alken ◽  
K Scherschel ◽  
M Masjedi ◽  
O Grebe ◽  
C Meyer
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Contact Force ◽  
Electromechanical Coupling ◽  
Linear Regression Analysis ◽  
Lesion Formation ◽  
Density Mapping ◽  
Recurrent Atrial Fibrillation ◽  
Rf Energy ◽  
Catheter Stability

Abstract Funding Acknowledgements Type of funding sources: None. Background  Contact force (CF) and local impedance (LI) have been separately established for radiofrequency (RF) catheter ablation guidance, enabling estimation of mechanical catheter stability and underlying electrical tissue substrate properties, respectively. However, simultaneous investigation for evaluation of combined electromechanical coupling during RF energy delivery has not been conducted in-human.  Purpose  Evaluation of the relationship of CF to LI during catheter-based RF atrial fibrillation / tachycardia ablation.  Methods  In this explorative study, patients presenting with recurrent atrial fibrillation and/or atrial tachycardia for ablation after previous index AF ablation were enrolled. A novel open-irrigated single-tip ablation catheter capable of continuously assessing CF and LI was used after initial high-density mapping. Baseline LI, CF and local bipolar voltage were assessed for each ablation site, with subsequent analysis of mean CF and the force-time integral (FTI) during ablation as well as the maximum LI drop (ΔLI), reflecting acute lesion formation during RF delivery. Results  In 11 patients [n = 5 female, mean age 66 ± 11 years, median previous procedures n = 2 (interquartile range 1-2)], overall 364 RF energy deliveries were analysed after exclusion of lesions indicating catheter instability or lesions with a RF-duration <10 s. Acute procedural success was reached in all patients, with no periprocedural complications observed.  CF showed a weak correlation to baseline LI during linear regression analysis (r = 0.29, p < 0.001). Baseline LI as well as ΔLI were higher in regions of high (>0.5 mV) vs intermediate (0.1–0.5 mV) or low (<0.1 mV) voltage (baseline LI: p < 0.001, ΔLI: p = 0.04). The ΔLI was more strongly related to baseline LI (r = 0.38, p < 0.001) compared to mean CF / FTI during ablation (r = 0.16, p = 0.003 / r = 0.15, p = 0.008). However, a CF ≥5 g and FTI ≥400 gs were associated with increased ΔLI compared to CF levels <5 g / FTI <400 gs (CF: p = 0.006, FTI: p = 0.008, Figure 1). Ablation sites in the right atrium displayed higher ΔLI when applying sufficient mean CF levels ≥5 g compared to the left atrium (22 (16-30) vs 16 (13-22) Ω, p = 0.008). Sufficient lesion formation was previously observed to be accomplished at a ΔLI ≥20 Ω, which was predicted best by baseline LI [odds ratio 1.07 (confidence interval 1.05-1.09), p < 0.001)] compared with CF [1.01 (0.97-1.05), p = 0.636], FTI [1.002 (1.00-1.003), p = 0.02] and local voltage [1.064 (0.76–1.4), p = 0.38].  Conclusion  Simultaneous monitoring of LI and CF enables real-time analysis of (1) local catheter stability by pertaining CF levels beyond 5 g while concomitantly (2) characterising underlying substrate using the baseline LI and (3) estimating the effect of applied RF energy on lesion formation by assessing the ΔLI. This may enhance intra-procedural evaluation of effective RF delivery for tailored ablation procedures. Abstract Figure. CF and LI assessment during RF ablation

Repeat Catheter Ablation for Recurrent Atrial Fibrillation: Electrophysiologic Findings and Clinical Outcomes

2021 ◽  
Author(s):  
Usama A. Daimee ◽  
Tauseef Akhtar ◽  
Thomas A. Boyle ◽  
Leah Jager ◽  
Armin Arbab‐Zadeh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Recurrent Atrial Fibrillation

scholarly journals Catheter ablation in adults with congenital heart disease: a 15-year perspective from a tertiary center

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Waldmann ◽  
D Amet ◽  
A Zhao ◽  
M Ladouceur ◽  
C Karsenty ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Catheter Ablation ◽  
Success Rate ◽  
Contact Force ◽  
Congenital Heart ◽  
3D Mapping ◽  
Density Mapping ◽  
Tertiary Center ◽  
Procedural Success

Abstract Background With the growing population of adults with congenital heart disease (ACHD), the number of catheter ablation procedures is expected to increase over time. Purpose We aimed to describe temporal trends in volume and outcomes of catheter ablation procedures in ACHD patients in a large tertiary center. Methods Retrospective observational study including all consecutive ACHD patients undergoing catheter ablation in a tertiary reference center over a 15-year period. Acute procedural success rate (including complete success in case of non-inducibility of any arrhythmia at the end of the procedure) as well as freedom from recurrence at 12 months were analyzed. Results From November 2004 to November 2019, 302 catheter ablations in 221 ACHD patients (43.6±15.0 years, 58.9% males) were performed. The annual number of catheter ablation increased progressively from 4 to 60 by year (p<0.001). Intra-atrial reentrant tachycardia/focal atrial tachycardia was the most common targeted arrhythmia (n=217, 71.9%). Over the study period, acute procedural success rate increased from 45.0% to 93.3% (p<0.001), including complete acute procedural success from 45.0% to 88.1% (p<0.001) (Figure 1). The use of irrigated catheters (30.0% to 94.8%, p<0.001), 3D-mapping systems (60.0% to 96.3%, p<0.001), contact force catheters (0.0% to 91.9%, <0.001), and high-density mapping (0.0% to 71.9%, p<0.01) increased significantly. Use of irrigated catheters (OR=3.96, 95% CI: 1.79–8.55), 3D-mapping system (OR=3.55, 95% CI: 1.62–7.55), contact force catheters (OR=3.46, 95% CI: 1.71–7.25), and high-density mapping (OR=3.85, 95% CI: 1.60–7.26) were associated with acute procedural success. The rate of freedom from any recurrence at 12 months increased from 29.4% to 66.2% (p=0.001). Seven (2.3%) non-fatal complications occurred. Conclusions The number of catheter ablation procedures in ACHD patients has considerably increased over the last 15 years. Advances in ablative technologies appear to be associated with a low rate of complications and a significant improvement in acute and midterm outcomes. Evolution of acute procedural success Funding Acknowledgement Type of funding source: None

scholarly journals Outcome of contact force-guided radiofrequency catheter ablation or second generation cryoballoon ablation for paroxysmal atrial fibrillation: propensity score matched analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Ukita ◽  
A Kawamura ◽  
H Nakamura ◽  
K Yasumoto ◽  
M Tsuda ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Propensity Score ◽  
Contact Force ◽  
Paroxysmal Atrial Fibrillation ◽  
Radiofrequency Catheter Ablation ◽  
Second Generation ◽  
Late Recurrence ◽  
Cryoballoon Ablation ◽  
Atrial Tachyarrhythmia

Abstract Background Little has been reported on the outcome of contact force (CF)-guided radiofrequency catheter ablation (RFCA) and second generation cryoballoon ablation (CBA). Purpose The purpose of this study was to compare the outcome of CF-guided RFCA and second generation CBA for paroxysmal atrial fibrillation (PAF). Methods We enrolled the consecutive 364 patients with PAF who underwent initial ablation between September 2014 and July 2018 in our hospital. We compared the late recurrence of atrial tachyarrhythmia more than three months after ablation between RFCA group and CBA group. All RFCA procedures were performed using CF-sensing catheter and all CBA procedures were performed using second generation CB. Results There were significant differences in background characteristics: chronic kidney disease, serum brain natriuretic peptide level, and left ventricular ejection fraction. After propensity score matched analysis (Table), atrial tachyarrhythmia free survival was significantly higher in CBA group than in RFCA group (Figure). Conclusions Second generation CBA showed a significantly lower late recurrence rate compared to CF-guided RFCA. Kaplan-Meier Curve Funding Acknowledgement Type of funding source: None

Real-time local impedance monitoring to assess tissue lesion during pulmonary vein isolation: a new tool for AF ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Di Cori ◽  
L Segreti ◽  
G Zucchelli ◽  
S Viani ◽  
F Tarasco ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Vascular Complications ◽  
Lesion Formation ◽  
Tissue Impedance ◽  
Af Ablation ◽  
Group 2 ◽  
Group 1

Abstract Background Contact force catheter ablation is the gold standard for treatment of atrial fibrillation (AF). Local tissue impedance (LI) evaluation has been recently studied to evaluate lesion formation during radiofrequency ablation. Purpose Aim of the study was to assess the outcomes of an irrigated catether with LI alghorithm compared to contact force (CF)-sensing catheters in the treatment of symptomatic AF. Methods A prospective, single-center, nonrandomized study was conducted, to compare outcomes between CF-AF ablation (Group 1) and LI-AF ablation (Group 2). For Group 1 ablation was performed using the Carto 3© System with the SmartTouch SF catheter and, as ablation target, an ablation index value of 500 anterior and 400 posterior. For Group 2, ablation was performed using the Rhythmia™ System with novel ablation catheter with a dedicated algorithm (DirectSense) used to measure LI at the distal electrode of this catheter. An absolute impedance drop greater than 20Ω was used at each targeted. According to the Close Protocol, ablation included a point by point pulmonary vein isolation (PVI) with an Inter-lesion space ≤5 mm in both Groups. Procedural endpoint was PVI, with confirmed bidirectional block. Results A total of 116 patients were enrolled, 59 patients in Group 1 (CF) and 57 in Group 2 (LI), 65 (63%) with a paroxismal AF and 36 (37%) with a persistent AF. Baseline patients features were not different between groups (P=ns). LI-Group showed a comparable procedural time (180±89 vs 180±56, P=0.59) but with a longer fluoroscopy time (20±12 vs 13±9 min, P=0.002). Wide antral isolation was more often observed in CF-Group (95% vs 80%, P=0.022), while LI-Group 2 required frequently additional right or left carina ablation (28% vs 14%, P=0.013). The mean LI was 106±14Ω prior to ablation and 92.5±11Ω after ablation (mean LI drop of 13.5±8Ω) during a median RF time of 26 [19–34] sec for each ablation spot. No steam pops or complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated in all study patients. Regarding safety, only minor vascular complications were observed (5%), without differences between groups (p=0.97). During follow up, 9-month freedom from atrial fibrillation/atrial flutter/atrial tachycardia recurrence was 86% in Group 1 and 75% in Group 2 (P=0.2). Conclusions An LI-guided PV ablation strategy seems to be safe and effective, with acute and mid-term outcomes comparable to the current contact force strategy. LI monitoring could be a promising complementary parameter to evaluate not only wall contact but also lesion formation during power delivery. Procedural Outcomes Funding Acknowledgement Type of funding source: None

Application of recurrence plot analysis to characterise whole chamber propagation of atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Pope ◽  
P Kuklik ◽  
A Briosa E Gala ◽  
M Leo ◽  
J Paisey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Charge Density ◽  
De Novo ◽  
Inverse Correlation ◽  
Right Atrial ◽  
Research Centre ◽  
Activation Patterns ◽  
Density Mapping ◽  
Distance Matrices

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Oxford Biomedical Research Centre Introduction Non-contact charge density mapping allows visualisation of whole chamber propagation during atrial fibrillation (AF). The identification of regions with repetitive or, conversely, more complex patterns of wavefront propagation may provide clues to mechanisms responsible for AF maintenance and lead to improved outcomes from catheter ablation. Our novel mapping approach based on signal recurrence plots has never been applied to whole chamber, bi-atrial recording of atrial fibrillation. Purpose To apply recurrence analysis to characterise whole chamber bi-atrial AF propagation. Methods Non-contact dipole signals from left and right atrial maps were obtained during simultaneous bi-atrial charge density mapping of AF. Signals were converted to phase and mean phase coherence calculated for the generation of recurrence distance matrices for the whole chamber and each anatomical region (6x LA and 4x RA) over the 30-second recording duration, where a value of 1 (purple, see figure panel A) represents uniform repetitive conduction, and 0 (red), irregular, non-repetitive activity. Whole chamber and regional mean recurrence values were calculated and correlated with the frequency of wavefronts of localised irregular activation patterns. Results Maps were obtained prior to ablation in 21 patients (5 paroxysmal (pAF), 16 persistent AF (persAF)) undergoing de-novo catheter ablation procedures. Whole chamber recurrence was higher in patients with pAF (0.40 ± 0.08) than persAF (0.34 ± 0.05), p < 0.0005. There was an inverse correlation between regional recurrence values and the number of localised irregular activations detected (-0.7021, p < 0.0005, figure panel B) with the lateral LA and anterior RA demonstrating the highest recurrence values in each chamber (figure panel C). Conclusion Use of recurrence distance matrices characterises global AF propagation phenotypes. Regional values are inversely correlated with the frequency of localised irregular activation patterns identified demonstrating an anatomic dependence in the level of AF propagation complexity, greatest in the anterior LA and septal RA. Comparison of strategies targeting regions with maximal vs. minimal values during catheter ablation may define an optimal approach to treatment of persistent AF. Abstract Figure. Recurrence abstract figure

Approach and strategy for repeat catheter ablation of recurrent atrial fibrillation

2019 ◽  
Vol 31 (7) ◽  
pp. 1874-1876
Author(s):  
Emrie Tomaiko ◽  
Andrew Tseng ◽  
William B. Reichert ◽  
Wilber W. Su
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Recurrent Atrial Fibrillation
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