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July 16, 2020Journal of Cardiovascular Electrophysiology

An LI drop of 13.4 Ω predicted sufficient lesion formation without a gap with a sensitivity of 0.78, specificity of 0.75, and predictive accuracy of 0.75.

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Why the study?

Target local impedance measurements at each radiofrequency application for creating sufficient ablation lesions during pulmonary vein isolation were explored.

Does local impedance drop predict sufficient lesion formation without a conduction gap during pulmonary vein isolation in patients with paroxysmal AF?

Population

15 consecutive patients scheduled for initial ablation of paroxysmal AF

Comparison

Ablation points with vs without a conduction gap

Design

Prospective operator-blinded study

Authors

MMMasaharu MasudaTKTakashi KandaNKNaoya Kurata

Discussion

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Overview

May aid lesion assessment during PVI; hypothesis-generating and requires prospective validation before guiding practice.

Key Points

  • To identify target local impedance drops during radiofrequency catheter ablation that indicate sufficient lesion formation without conduction gaps during pulmonary vein isolation.
  • Enrolled 15 consecutive patients undergoing initial ablation for paroxysmal atrial fibrillation.
  • Performed point-by-point circumferential pulmonary vein isolation with a 4-mm irrigated catheter containing a local impedance sensor and a 4-mm inter-ablation distance, with operators blinded to impedance values.
  • Conduction from the left atrium to pulmonary veins remained in 12 of 30 (40%) ipsilateral veins after initial encircling, revealing 48 gap points.
  • Local impedance drop was significantly lower at points with a conduction gap than at points without a gap (12 ± 7 vs. 23 ± 12 Ω; p < .001), while generator impedance drop showed no difference (12 ± 7 vs. 14 ± 10 Ω; p = .10).
  • A local impedance drop cutoff of 13.4 Ω predicted gap-free lesion formation with a sensitivity of 0.78, specificity of 0.75, and accuracy of 0.75.

Structured PICO

Does local impedance drop predict sufficient lesion formation without a conduction gap during pulmonary vein isolation in patients with paroxysmal AF?

P
Population
15 consecutive patients scheduled to undergo an initial ablation of paroxysmal atrial fibrillation (AF)
I
Intervention
Circumferential ablation around both ipsilateral PVs using a 4-mm irrigated ablation catheter with a local impedance (LI) sensor, using point-by-point ablation with a 4-mm inter-ablation-point distance
O
Outcome
Creation of sufficient ablation lesions assessed by the absence of a conduction gapsurrogate

A local impedance drop of 13.4 Ω during radiofrequency ablation predicts sufficient lesion formation without conduction gaps during pulmonary vein isolation.

Cite This Study

Masuda et al. (2020) studied this question.

synapsesocial.com/papers/6a0ff0fe2badbc352aff0392https://doi.org/10.1111/jce.14678
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Insight into contact force local impedance technology for predicting effective pulmonary vein isolation2023 · 12 citations
  2. 2A novel local impedance algorithm to guide effective pulmonary vein isolation in atrial fibrillation patients: Preliminary experience across different ablation sites from the CHARISMA pilot study2020 · 31 citations
  3. 3Change in the local impedance and electrograms recorded by a micro‐electrode tip catheter during initial atrial fibrillation ablation2021 · 9 citations
  4. 4Local catheter impedance drop during pulmonary vein isolation predicts acute conduction block in patients with paroxysmal atrial fibrillation: initial results of the LOCALIZE clinical trial2021 · 71 citations
  5. 5Lesion effects in terms of local impedance variations after pulsed-field ablation during pulmonary vein isolation: a case report2023 · 5 citations