Ablation catheter motion detection during contact force and VISITAG™ Module-guided pulmonary vein isolation

Background: During contact force (CF) and VISITAG™ Module (Biosense Webster) guided pulmonary vein isolation (PVI), ACCURESP™ respiratory motion adjustment is recommended, although without in vivo validation. Objective: Since accurate LAPW radiofrequency (RF) annotation is crucial to avoid oesophageal thermal injury, we compared ACCURESP™ setting ("on" versus "off") on RF annotation at the left atrial posterior wall (LAPW). Methods: From a twenty-five patient cohort undergoing CF PVI (continuous RF, 30W) using general anaesthesia and VISITAG™ Module annotation-guidance (force-over-time 100% minimum 1g, 2mm position stability, ACCURESP™ "off"), respiratory motion detection occurred in eight, permitting retrospective comparison of ACCURESP™ settings. Results: There were significant differences in LAPW RF data annotation according to ACCURESP™ setting. Comparing ACCURESP™ "on" versus "off", respectively: Total annotated sites 82 versus 98; Median RF duration per-site 13.3s versus 10.6s (p<0.0001); Median force time integral 177g.s versus 130g.s (p=0.0002); Mean inter-lesion distance (ILD) 6.0mm versus 4.8mm (p=0.002). Considering only annotated site 1-to-2 transitions, three occurred with 0g CF; ACCURESP™ "on" minus "off" difference in RF duration was <0.6s. However, thirteen site 1-to-2 transitions during constant catheter-tissue contact (ILD range 2.1 - 7.0mm) demonstrated a mean difference in annotated RF duration at site 1, of 3.7s (Range: -1.3 - 11.3s). Reconstituted curves displaying catheter position data, CF, impedance and site 1-to-2 transition according to ACCURESP™ setting, demonstrated multiple markers of catheter movement coinciding with ACCURESP™ "off". Conclusions: ACCURESP™ "off" setting demonstrated excellent catheter movement detection properties and represents an optimal method towards the annotation of stable sites of RF delivery at the LAPW.