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November 15, 2018EP Europace

Local impedance measurement during catheter ablation yielded a mean impedance drop of 13.1 Ω compared to 6.1 Ω for generator impedance (P<0.001), serving as a better predictor of impedance drops.

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Why the study?

A novel measure of local impedance was found to predict lesion formation during RFC catheter ablation, prompting investigation of its utility compared with generator impedance.

Does local impedance measurement better predict impedance drops during radiofrequency catheter ablation compared to generator impedance in patients with atrial fibrillation?

Population

25 consecutive patients with a history of atrial fibrillation (381 RFC applications)

Comparison

Local impedance vs generator impedance measurements

Design

Consecutive observational cohort study

Key result

Local impedance measurement during catheter ablation yielded a mean impedance drop of 13.1 Ω compared to 6.1 Ω for generator impedance (P<0.001), serving as a better predictor of impedance drops.

Authors

MGMelanie GunawardenePMPaula MünklerCEChristian Eickholt

Discussion

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Overview

May support local impedance over generator impedance for guiding AF ablation lesions; hypothesis-generating and requires confirmation in randomized studies.

Key Points

  • To evaluate the clinical utility of catheter-tip local impedance measurements compared to standard generator impedance for monitoring catheter-tissue coupling and lesion formation during radiofrequency catheter ablation.
  • Assessed 25 consecutive patients with a history of atrial fibrillation undergoing catheter ablation guided by a 3D-mapping system.
  • Measured local impedance using three mini-electrodes on the catheter tip alongside standard generator impedance across 381 radiofrequency applications.
  • Baseline local impedance was significantly higher in high-voltage tissue (>0.5 mV; 110.5 ± 13.7 Ω) than in intermediate-voltage tissue (90.9 ± 10.1 Ω, P < 0.001), low-voltage tissue (91.9 ± 16.4 Ω, P < 0.001), and blood pool (91.9 ± 9.9 Ω, P < 0.001).
  • Mean local impedance drop during ablation (13.1 ± 9.1 Ω) was 2.15 times greater than generator impedance drop (6.1 ± 4.2 Ω, P < 0.001), with baseline local impedance strongly predicting impedance drop (mean 99.9 Ω predicted 12.9 Ω drop, 95% CI [12.1, 13.6], R² = 0.41, P < 0.001) compared to baseline generator impedance (R² = 0.06, P < 0.001).
  • Catheter movements were mirrored by rapid shifts in local impedance, while application duration did not predict coupling changes for either local (P = 0.247) or generator impedance (P = 0.376).

Study Design

Type

Observational (n=25)

Structured PICO

Does local impedance measurement better predict impedance drops during radiofrequency catheter ablation compared to generator impedance in patients with atrial fibrillation?

P
Population
25 consecutive patients with a history of atrial fibrillation undergoing catheter ablation.
E
Exposure
Catheter ablation guided by a 3D-mapping system measuring local impedance (LI) via an ablation catheter tip with three incorporated mini-electrodes
C
Comparator
Generator impedance (GI) measurement
O
Outcome
Local impedance (LI) and generator impedance (GI) before and during radiofrequency current (RFC) applicationssurrogate

Main Result

Absolute Event Rate: 13.1% vs 6.1%

p-value: p=<0.001

Local impedance measurement during catheter ablation provides a better predictor of impedance drops than traditional generator impedance, potentially offering better insights into lesion formation.

Limitations

  • Further studies are needed to investigate if this novel approach is useful to guide catheter ablation.

Cite This Study

Gunawardene et al. (2018) conducted an observational in Atrial fibrillation (n=25). Local impedance (LI) measurement vs. Generator impedance (GI) measurement was evaluated on Mean impedance drop during ablation (p=<0.001). Local impedance measurement during catheter ablation yielded a mean impedance drop of 13.1 Ω compared to 6.1 Ω for generator impedance (P<0.001), serving as a better predictor of impedance drops.

synapsesocial.com/papers/6a7723da576efb0ddaf71ce6https://doi.org/10.1093/europace/euy273
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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 guides catheter ablation in patients with ventricular tachycardia2019 · 26 citations
  2. 2Change in the local impedance and electrograms recorded by a micro‐electrode tip catheter during initial atrial fibrillation ablation2021 · 9 citations
  3. 3Novel Measure of Local Impedance Predicts Catheter–Tissue Contact and Lesion Formation2018 · 105 citations
  4. 4A 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
  5. 5Clinical utility of local impedance monitoring during pulmonary vein isolation2020 · 14 citations