October 13, 2022Frontiers in PhysiologyOpen Access

Combined contact force and baseline local impedance predicted a maximum local impedance drop >20 Ω with an AUC of 0.75, outperforming either parameter alone during repeat ablation.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Repeat atrial fibrillation or atrial tachycardia (n=20). Intervention: Combined contact force and baseline local impedance vs. Baseline local impedance or mean contact force alone. Primary outcome: Prediction of maximum local impedance drop > 20 Ω (AUC 0.75, 95% CI 0.71-0.79, p=<0.001).

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Why the study?

Optimal lesion formation during RFC ablation depends on electro-mechanical tip-tissue coupling, but CF and LI dynamics required investigation in patients undergoing repeat ablation who frequently present with heterogenous arrhythmia substrate.

Does combined contact force and local impedance monitoring predict successful lesion formation (∆LI > 20 Ω) in patients undergoing repeat atrial fibrillation or atrial tachycardia ablation?

Population

20 consecutive patients presenting for repeat AF or atrial tachycardia ablation (730 RFC applications)

Comparison

CF and LI dynamics across RFC applications

Design

Observational study

Key result

Combined contact force and baseline local impedance predicted a maximum local impedance drop >20 Ω with an AUC of 0.75, outperforming either parameter alone during repeat ablation.

Authors

FAFares‐Alexander Alken KSKatharina Scherschel AKAnn‐Kathrin Kahle

Discussion

Member takes

Overview

Hypothesis-generating for combined contact force-impedance guidance in repeat ablation; prospective validation needed before practice change.

Study Design

Type

Observational (n=20)

Multicenter

Structured PICO

Does combined contact force and local impedance monitoring predict successful lesion formation (∆LI > 20 Ω) in patients undergoing repeat atrial fibrillation or atrial tachycardia ablation?

Population

20 patients (mean age 66 years, 40% female) undergoing repeat catheter ablation for symptomatic atrial fibrillation or atrial tachycardia, contributing 730 analyzed radiofrequency applications.

Exposure

Radiofrequency current (RFC) ablation using an open-irrigated single-tip ablation catheter capable of continuously assessing contact force (CF) and local impedance (LI).

Outcome

Maximum local impedance drop (∆LI) during ablation, with ∆LI > 20 Ω defined as a successful RFC application.surrogate

Main Result

Effect estimate: AUC 0.75 (95% CI 0.71-0.79)

p-value: p=<0.001

Combining contact force and local impedance monitoring during repeat atrial fibrillation ablation improves the prediction of effective lesion formation, particularly in regions of low voltage.

Limitations

Single-center retrospective explorative study with a relatively small sample size
Ablation was not prospectively guided by local impedance measurement
Target ΔLI may vary from levels proposed in previous studies due to heterogenous regions of healthy and impaired myocardium
Lack of long-term follow-up data on arrhythmia outcomes

Cite This Study

Alken et al. (2022) conducted an observational in Repeat atrial fibrillation or atrial tachycardia (n=20). Combined contact force and baseline local impedance vs. Baseline local impedance or mean contact force alone was evaluated on Prediction of maximum local impedance drop > 20 Ω (AUC 0.75, 95% CI 0.71-0.79, p=<0.001). Combined contact force and baseline local impedance predicted a maximum local impedance drop >20 Ω with an AUC of 0.75, outperforming either parameter alone during repeat ablation.

synapsesocial.com/papers/6a1fe2adfd96d06e05430fb9 https://doi.org/10.3389/fphys.2022.1001719

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October 13, 2022Frontiers in PhysiologyOpen Access

Combined contact force and baseline local impedance predicted a maximum local impedance drop >20 Ω with an AUC of 0.75, outperforming either parameter alone during repeat ablation.

View Full Paper

Ask AI

Bookmark

Why the study?

Does combined contact force and local impedance monitoring predict successful lesion formation (∆LI > 20 Ω) in patients undergoing repeat atrial fibrillation or atrial tachycardia ablation?

Population

20 consecutive patients presenting for repeat AF or atrial tachycardia ablation (730 RFC applications)

Comparison

CF and LI dynamics across RFC applications

Design

Observational study

Key result

Combined contact force and baseline local impedance predicted a maximum local impedance drop >20 Ω with an AUC of 0.75, outperforming either parameter alone during repeat ablation.

Authors

FAFares‐Alexander Alken KSKatharina Scherschel AKAnn‐Kathrin Kahle

Discussion

Member takes

Overview

Hypothesis-generating for combined contact force-impedance guidance in repeat ablation; prospective validation needed before practice change.

Study Design

Type

Observational (n=20)

Multicenter

Structured PICO

Does combined contact force and local impedance monitoring predict successful lesion formation (∆LI > 20 Ω) in patients undergoing repeat atrial fibrillation or atrial tachycardia ablation?

Population

20 patients (mean age 66 years, 40% female) undergoing repeat catheter ablation for symptomatic atrial fibrillation or atrial tachycardia, contributing 730 analyzed radiofrequency applications.

Exposure

Radiofrequency current (RFC) ablation using an open-irrigated single-tip ablation catheter capable of continuously assessing contact force (CF) and local impedance (LI).

Outcome

Maximum local impedance drop (∆LI) during ablation, with ∆LI > 20 Ω defined as a successful RFC application.surrogate

Main Result

Effect estimate: AUC 0.75 (95% CI 0.71-0.79)

p-value: p=<0.001

Combining contact force and local impedance monitoring during repeat atrial fibrillation ablation improves the prediction of effective lesion formation, particularly in regions of low voltage.

Limitations

Single-center retrospective explorative study with a relatively small sample size
Ablation was not prospectively guided by local impedance measurement
Target ΔLI may vary from levels proposed in previous studies due to heterogenous regions of healthy and impaired myocardium
Lack of long-term follow-up data on arrhythmia outcomes

Cite This Study

synapsesocial.com/papers/6a1fe2adfd96d06e05430fb9 https://doi.org/10.3389/fphys.2022.1001719

Also Consider

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

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