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September 8, 2026Journal of Interventional Cardiac ElectrophysiologyOpen Access

An optimal output and electrode configuration for evaluating tissue transmurality - a preclinical study

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Why the study?

Achieving transmural lesions is critical for durable catheter ablation outcomes, but the optimal electrode configuration and cutoff values for electrogram amplitude reduction and pacing threshold changes remain unclear.

Does conventional bipolar configuration outperform microelectrode configurations in predicting atrial lesion transmurality during radiofrequency ablation in a swine model?

Population

14 swine with 131 atrial lesions

Comparison

Conventional bipolar vs microelectrode bipolar vs unipolar configurations using the QDOT MICRO catheter

Design

Preclinical study

Key result

Conventional bipolar electrodes outperformed microelectrode configurations in predicting atrial lesion transmurality, with the post-ablation pacing threshold yielding the highest diagnostic accuracy (AUC 0.880 at a 3.4 V cutoff).

Authors

IKIwanari KawamuraAFAiko FujimakiMTMasateru Takigawa

Discussion

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Overview

Electrode data from this swine model remain preliminary; leaves open whether microelectrode cutoffs improve transmurality prediction in patients.

Key Points

  • To identify the optimal electrode configuration and cutoff values for electrogram amplitude and pacing threshold to evaluate tissue transmurality during atrial catheter ablation.
  • Performed radiofrequency ablation in 14 swine to generate 131 atrial lesions using the QDOT MICRO catheter.
  • Measured electrogram amplitudes and pacing thresholds pre- and post-ablation using conventional bipolar, microelectrode bipolar, and unipolar configurations.
  • Assessed lesion transmurality histologically and determined predictive accuracy using receiver operating characteristic (ROC) analyses.
  • Conventional bipolar (A1–A2) pacing threshold achieved the highest accuracy in predicting transmural lesions (AUC 0.880, optimal cutoff 3.4 V).
  • Post-ablation bipolar electrogram amplitudes were significantly lower in transmural lesions (AUC 0.777, cutoff 0.86 mV), with greater relative amplitude reduction compared to non-transmural lesions (64.4% vs. 40.5%, AUC 0.682).
  • Microelectrode configurations and electrogram morphology changes, such as the loss of bipolar R-waves (AUC ≤ 0.77) and unipolar S-waves (AUC ≤ 0.56), showed limited predictive value.

Structured PICO

Does conventional bipolar configuration outperform microelectrode configurations in predicting atrial lesion transmurality during radiofrequency ablation in a swine model?

P
Population
14 swine (45-65 kg) undergoing right atrial radiofrequency ablation to create 131 lesions for the evaluation of tissue transmurality.
I
Intervention
Conventional bipolar (A1-A2) configuration using the QDOT MICRO catheter
C
Comparator
Microelectrode bipolar and unipolar configurations
O
Outcome
Predictive accuracy of lesion transmurality (determined histologically) using pacing thresholds and electrogram amplitudessurrogate

Main Result

Effect estimate: AUC 0.880

Conventional tip-to-ring bipolar pacing with a 3.4 V threshold is the most accurate method for assessing atrial lesion transmurality during radiofrequency ablation.

Limitations

  • Derived from an in vivo porcine right atrium model, which may not directly extrapolate to the thicker and more heterogeneous human left atrium or ventricular tissue.
  • Analysis was intentionally limited to smooth endocardial surfaces, excluding trabeculated regions from the primary analysis.
  • Results and the optimal cutoff value of 3.4 V are specific to the QDOT MICRO catheter platform and a pulse width of 1.0 ms.
  • Catheter orientation was not standardized or quantitatively recorded.
  • Findings are limited to measurements obtained with a contact force of approximately 10 g and may not apply to very low or high contact forces.
  • Lesion width and surface dimensions were not systematically quantified.

Cite This Study

Kawamura et al. (2026) studied Atrial tissue transmurality (preclinical model) (n=14). Conventional bipolar configuration (A1-A2) vs. Microelectrode configurations was evaluated on Predictive accuracy of pacing threshold for lesion transmurality (AUC 0.880). Conventional bipolar electrodes outperformed microelectrode configurations in predicting atrial lesion transmurality, with the post-ablation pacing threshold yielding the highest diagnostic accuracy (AUC 0.880 at a 3.4 V cutoff).

synapsesocial.com/papers/6aa0091858e84d0ff5b47c3ahttps://doi.org/10.1007/s10840-026-02422-7
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