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January 7, 2021EP EuropaceOpen Access

Acutely blocked segments during pulmonary vein isolation had a significantly larger local impedance drop (median 19.8 Ω) compared with segments with gaps (10.6 Ω, P<0.001).

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Why the study?

Larger local impedance drops correlate with more effective lesion formation, but whether local impedance drop is associated with conduction block during pulmonary vein isolation remained to be evaluated.

Does local impedance drop predict acute conduction block in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation?

Comparison

Segments with acute conduction block vs segments with gaps

Design

LI-blinded clinical trial

Follow-up

20-min waiting period

Key result

Acutely blocked segments during pulmonary vein isolation had a significantly larger local impedance drop (median 19.8 Ω) compared with segments with gaps (10.6 Ω, P<0.001).

Authors

MDMoloy DasALArmin LuikESEwen Shepherd

Discussion

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Member takes

Overview

Supports local impedance drop as a marker of acute block in PVI; leaves open whether targeting larger drops improves durable isolation.

Key Points

  • To evaluate whether local impedance drop measured at the ablation catheter tip is associated with acute conduction block during pulmonary vein isolation in paroxysmal atrial fibrillation.
  • Sixty patients (N=60) underwent local impedance-blinded de novo pulmonary vein isolation using a point-by-point radiofrequency ablation workflow.
  • Pulmonary vein rings were divided into 16 anatomical segments, and conduction gaps were mapped following a 20-minute waiting period.
  • Median local impedance drop within segments with an inter-lesion distance ≤6 mm was evaluated offline using receiver operating characteristic analysis.
  • For segments with inter-lesion distance ≤6 mm, acutely blocked segments had a significantly larger local impedance drop than segments with gaps (19.8 [14.1–27.1] Ω vs. 10.6 [7.8–14.7] Ω, P < 0.001).
  • The optimal local impedance drop threshold to predict acute block was 16.1 Ω for anterior/roof segments (positive predictive value: 96.3%) and 12.3 Ω for posterior/inferior segments (positive predictive value: 98.1%).

Study Design

Type

Observational (n=60)

Blinding

Single-blind

Structured PICO

Does local impedance drop predict acute conduction block in patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation?

P
Population
60 patients with paroxysmal atrial fibrillation undergoing de novo pulmonary vein isolation.
E
Exposure
Radiofrequency ablation using a point-by-point workflow with evaluation of local impedance (LI) drop (operators blinded to LI)
O
Outcome
Acute segment conduction block (assessed after a 20-min waiting period)surrogate

Main Result

Absolute Event Rate: 19.8% vs 10.6%

p-value: p=< 0.001

The magnitude of local impedance drop during radiofrequency ablation is highly predictive of acute pulmonary vein isolation segment conduction block, with different optimal cut-offs depending on atrial wall thickness.

Cite This Study

Das et al. (2021) conducted an observational in paroxysmal atrial fibrillation (n=60). Local impedance drop vs. Segments with gaps was evaluated on acute segment conduction block (p=< 0.001). Acutely blocked segments during pulmonary vein isolation had a significantly larger local impedance drop (median 19.8 Ω) compared with segments with gaps (10.6 Ω, P<0.001).

synapsesocial.com/papers/6a7723da576efb0ddaf71ce4https://doi.org/10.1093/europace/euab004
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Also Consider

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

  1. 1Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation2022 · 23 citations
  2. 2Clinical utility of local impedance monitoring during pulmonary vein isolation2020 · 14 citations
  3. 3Insight into contact force local impedance technology for predicting effective pulmonary vein isolation2023 · 12 citations
  4. 4Local impedance drop as a predictor of sucessful pulmonary vein isolation2024
  5. 5Optimal local impedance parameters for successful pulmonary vein isolation in patients with atrial fibrillation2022 · 10 citations