Requirement of larger local impedance reduction for successful lesion formation at carinal area during pulmonary vein isolation

• Published in: Journal of interventional cardiac electrophysiology 2022-11, Vol.65 (2), p.509-518
• Main Authors: Ikenouchi, Takashi, Takigawa, Masateru, Goya, Masahiko, Martin, Claire A., Takahashi, Yoshihide, Shimizu, Yuki, Amemiya, Miki, Kamata, Tatsuaki, Nishimura, Takuro, Tao, Susumu, Miyazaki, Shinsuke, Sasano, Tetsuo
• Format: Article
• Language: English
• Subjects: Ablation; Cardiology; Catheters; Contact force; Durability; Impedance; Lesions; Lungs; Medical instruments; Medicine; Medicine & Public Health; Multivariate analysis; Parameters
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-022-01282-1

Purpose Local impedance (LI) measurement from an ablation catheter is useful in predicting lesion size and acute success of pulmonary vein isolation (PVI). The LI variation can be described by absolute LI drop (ΔLID) or ΔLID/initial LI (%LID). We evaluated the utility of these parameters in predicting acute lesion durability during PVI using a novel catheter capable of measuring both LI and contact force (CF). Methods PVI with a targeted CF, power, and duration was performed in 23 consecutive patients with paroxysmal atrial fibrillation. LI was blinded to operators during ablation. Parameters for each RF application were collected and compared for acute successful lesions and gaps. Results A total of 1633 RF applications including 97 (5.9%) gap lesions were analyzed. Successful lesions were more frequently observed at non-carinal sites and those with higher contact force, FTI, initial LI, and larger variation of LI and generator impedance (GI). Multivariate analysis demonstrated that absolute GI drop (ΔGID) [OR 1.09 (1.04–1.15), p