scholarly journals Transmural unipolar electrogram change occurs within 7 s at the left atrial posterior wall during pulmonary vein isolation

2019 ◽  
Vol 42 (7) ◽  
pp. 922-929
Author(s):  
David R. Tomlinson ◽  
Madison Myles ◽  
Kara N. Stevens ◽  
Adam J. Streeter
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Posterior Wall ◽  
Left Atrial Posterior ◽  
Unipolar Electrogram

scholarly journals Transmural unipolar electrogram morphology is achieved within 7s at the posterior left atrial wall during pulmonary vein isolation: VISITAG™ Module-based lesion assessment during radiofrequency ablation

2017 ◽  
Author(s):  
David R. Tomlinson ◽  
Madison Myles ◽  
Kara N. Stevens ◽  
Adam J. Streeter
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Left Atrial ◽  
Biological Effects ◽  
Posterior Wall ◽  
Morphology Change ◽  
Atrial Ablation ◽  
Left Atrial Posterior ◽  
Unipolar Electrogram

AbstractAimsTo assess the occurrence of a histologically validated measure of transmural (TM) atrial ablation – pure R unipolar electrogram (UE) morphology change – at first-ablated left atrial posterior wall (LAPW) sites during contact force (CF)-guided pulmonary vein isolation (PVI).Methods and resultsExported VISITAG™ Module and CARTOREPLAY™ (Biosense Webster Inc.) UE morphology data was retrospectively analysed in 23 consecutive patients undergoing PVI under general anaesthesia. PVI without spontaneous / dormant recovery was achieved in all, employing 16.3[3.2] minutes (mean [SD]) of temperature-controlled RF at 30W. All first-ablated LAPW sites demonstrated RS UE morphology pre-ablation, with RF-induced pure R UE morphology change in 98%. Time to pure R UE morphology was significantly shorter at left-sided LAPW sites (4.9[2.1] s versus 6.7[2.5] s; p=0.02), with significantly greater impedance drop (median 13.5Ω versus 9.9Ω; p=0.003). Importantly, neither the first-site RF duration (14.9 versus 15.0s) nor the maximum ablation catheter tip distance moved (during RF) were significantly different, yet the mean CF was significantly higher at right-sided sites (16.5g versus 11.2g; p=0.002). Concurrent impedance and objectively annotated bipolar electrogram (BE) data demonstrated ~6-8Ω impedance drop and ~30% BE decrease at the time of first pure R UE morphology change.ConclusionUsing objective ablation site annotation, TM UE morphology change was typically achieved within 7s at the LAPW, with significantly greater ablative effect evident at left-sided sites. The methodology described in this report represents a novel and scientifically more rigorous foundation towards future research into the biological effects of RF ablation in vivo.Condensed abstractThrough appropriate use of the VISITAG™ Module and CARTOREPLAY™, unipolar electrogram morphology change indicative of histologically confirmed transmural atrial ablation in animal models, was proven to occur typically within 7s, during first-site contact force-guided ablation at the left atrial posterior wall during pulmonary vein isolation.

scholarly journals Mechanistic insights into heterogeneous radiofrequency ablation effects at the left atrial posterior wall during pulmonary vein isolation

2019 ◽  
Author(s):  
David R. Tomlinson
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Posterior Wall ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Rf Ablation ◽  
Overdrive Pacing ◽  
Left Atrial Posterior ◽  
Tissue Motion

AbstractBackgroundIndependent investigations demonstrate greater radiofrequency (RF) ablation effects at left- sided left atrial posterior wall (LAPW) sites.ObjectiveTo investigate mechanisms underlying RF ablation heterogeneity during contact-force (CF) and VISITAG™ Module (Biosense Webster)-guided pulmonary vein isolation (PVI).MethodsConsecutive patients undergoing PVI during atrial overdrive pacing comprised 2 cohorts: intermittent positive pressure ventilation (IPPV, 14-16/min, 6-8ml/kg); high frequency jet ventilation (HFJV, 150/min, Monsoon III, Acutronic). Temperature-controlled (17ml/min, 48°C) RF data was retrospectively assessed at first-annotated (target 15s) LAPW sites: 30W during IPPV; 20W at left-sided sites during HFJV.ResultsTwenty-five and 15 patients underwent PVI during IPPV and HFJV, respectively. During IPPV, left versus right-sided median impedance drop (ImpD) was 13.6Ω versus 9.9Ω (p<0.0001) respectively and mean time to pure R unipolar electrogram (UE) morphology change 4.9s versus 6.7s (p=0.007) respectively. During HFJV, ImpD was greater at left-sided sites (9.7Ω versus 7.4Ω, p=0.21) and time to pure R UE significantly shorter: 4.3s versus 6.1s (p=0.02). Minimum case impedance subtracted from pre-RF baseline impedance (BI) generated site-specific ΔBI. Left-sided sites demonstrated significantly greater ΔBI, correlating strongly with Ln(ImpD) – IPPV r=0.84 (0.65 – 0.93), HFJV r=0.77 (0.35 – 0.93).At right-sided sites, ΔBI and Ln(ImpD) were without correlation during IPPV, but correlation was modest during HFJV (r=0.54, -0.007 – 0.84).ConclusionsΔBI may usefully indicate catheter-tissue contact surface area (SA). Consequently, greater left-sided LAPW RF effect may result from greater contact SA and in-phase catheter-tissue motion; HFJV may reduce right-sided out-of-phase catheter-tissue motion. Modifying RF delivery based on ΔBI may improve PVI safety and efficacy.

scholarly journals The relationship between oesophageal heating during left atrial posterior wall ablation and the durability of pulmonary vein isolation

EP Europace ◽  
2017 ◽  
Vol 19 (10) ◽  
pp. 1664-1669 ◽  
Author(s):  
V Nam Tran ◽  
Shigeki Kusa ◽  
Jeffrey Smietana ◽  
Wen-Chi Tsai ◽  
Kabir Bhasin ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Posterior Wall ◽  
The Relationship ◽  
Left Atrial Posterior

Impact of the size of non-ablated left atrial posterior wall area on outcomes after extensive encircling pulmonary vein isolation

2021 ◽  
Author(s):  
Shingo Yoshimura ◽  
Kenichi Kaseno ◽  
Kohki Kimura ◽  
Wataru Sasaki ◽  
Yoshinori Okazaki ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Posterior Wall ◽  
Wall Area ◽  
Left Atrial Posterior

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

2020 ◽  
Author(s):  
David Tomlinson ◽  
Katie Biscombe ◽  
John True ◽  
Joanne Hosking ◽  
Adam Streeter
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Motion Detection ◽  
Left Atrial ◽  
Respiratory Motion ◽  
Posterior Wall ◽  
Catheter Position ◽  
Force Time ◽  
Left Atrial Posterior

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, 30W) using general anaesthesia and automated RF annotation-guidance (VISITAG™: force-over-time 100% minimum 1g; 2mm 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 8, 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 13.3s versus 10.6s (p<0.0001); median force time integral 177g.s versus 130g.s (p=0.0002); mean inter-tag distance (ITD) 6.0mm versus 4.8mm (p=0.002). Considering LAPW annotated site 1-to-2 transitions resulting from deliberate catheter movement, 3 concurrent with inadvertent 0g CF demonstrated <0.6s difference in RF duration. However, 13 deliberate catheter movements during constant tissue contact (ITD range 2.1 – 7.0mm) demonstrated (mean) site-1 RF duration difference 3.7s (range: -1.3 to 11.3s): 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.

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