What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=46). Intervention: Local impedance (LI) drop vs. Generator impedance (GI) drop. Primary outcome: Successful ablation (OR 3.05, 95% CI 2.3-4.1, p=<0.0001).

What does this research mean for the field?

During radiofrequency pulmonary vein isolation for atrial fibrillation, each 5-point increment in local impedance drop is strongly associated with successful ablation, whereas generator impedance drop is not. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess tissue characteristics and evaluate whether local impedance changes can reliably predict successful lesion formation during pulmonary vein isolation compared to generator impedance.

July 2, 2020Journal of Cardiovascular Electrophysiology

A novel local impedance algorithm to guide effective pulmonary vein isolation in atrial fibrillation patients: Preliminary experience across different ablation sites from the CHARISMA pilot study

Q: What are the key findings of this study?

Every 5-point increment in local impedance drop during atrial fibrillation ablation was associated with successful ablation (OR 3.05; 95% CI 2.3-4.1; p<0.0001).

Q: What does this research mean for the field?

During radiofrequency pulmonary vein isolation for atrial fibrillation, each 5-point increment in local impedance drop is strongly associated with successful ablation, whereas generator impedance drop is not. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess tissue characteristics and evaluate whether local impedance changes can reliably predict successful lesion formation during pulmonary vein isolation compared to generator impedance.

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Key result

Local impedance drop during AF ablation is linked to ~205% higher success odds per 5-point increment.

OR 3.05
95% CI 2.3-4.1
P<0.0001
n=46

Why the study?

A novel technology to measure local impedance has become available, prompting evaluation of relationships between local and generator impedance parameters and procedural success in AF ablation.

Does a novel local impedance algorithm better predict effective lesion formation compared to generator impedance during pulmonary vein isolation in atrial fibrillation patients?

Population

46 AF ablation patients (2219 ablation spots) at 5 Italian centers

Comparison

Local impedance vs generator impedance parameters

Design

Multicenter registry-based pilot study

Authors

LSLuca SegretiElectrophysiology ASAntonio De SimoneElectrophysiology VSVincenzo SchillaciElectrophysiology

Discussion

Member takes

Implication

May support local impedance-guided lesion assessment in AF ablation; leaves open prospective validation versus generator impedance.

Key Points

To assess tissue characteristics and evaluate whether local impedance changes can reliably predict successful lesion formation during pulmonary vein isolation compared to generator impedance.
Analyzed 2,219 ablation spots across 46 consecutive patients undergoing radiofrequency catheter ablation for atrial fibrillation from the multicenter CHARISMA registry at five Italian centers.
Used a radiofrequency ablation catheter equipped with the DIRECTSENSE™ algorithm to monitor local impedance and guide pulmonary vein isolation.
Absolute drops in local impedance were significantly greater than drops in generator impedance following radiofrequency delivery (14 ± 8 Ω vs. 3.7 ± 5 Ω, p < 0.0001).
Every 5-point increment in local impedance drop strongly predicted successful ablation (OR = 3.05, 95% CI: 2.3–4.1, p < 0.0001), whereas generator impedance drops did not differ between successful and unsuccessful sites (3.7 ± 5 vs. 2.8 ± 4 Ω, p = 0.1099).
Complete pulmonary vein isolation was achieved in all 46 patients with no steam pops or major procedural complications.

Study Design

Type

Observational (n=46)

Multicenter

Yes

Structured PICO

Does a novel local impedance algorithm better predict effective lesion formation compared to generator impedance during pulmonary vein isolation in atrial fibrillation patients?

Population

46 patients undergoing atrial fibrillation ablation at five Italian centers, with 2219 ablation spots analyzed.

Exposure

Radiofrequency ablation guided by a novel local impedance algorithm to measure local impedance and guide ablation.

Comparator

Generator impedance parameters (within-spot comparison).

Outcome

Effective lesion formation (successful ablation) and pulmonary vein isolation.surrogate

Main Result

Odds Ratio: 3.05 (95% CI 2.3–4.1)

p-value: p=<0.0001

The magnitude of local impedance drop is a significantly better predictor of effective lesion formation than generator impedance drop during radiofrequency ablation for atrial fibrillation.

Cite This Study

Segreti et al. (2020) conducted an observational in Atrial fibrillation (n=46). Local impedance (LI) drop vs. Generator impedance (GI) drop was evaluated on Successful ablation (OR 3.05, 95% CI 2.3-4.1, p=<0.0001). Every 5-point increment in local impedance drop during atrial fibrillation ablation was associated with successful ablation (OR 3.05; 95% CI 2.3-4.1; p<0.0001).

synapsesocial.com/papers/6aa5f32e246eab12a27f395c https://doi.org/10.1111/jce.14647

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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July 2, 2020Journal of Cardiovascular Electrophysiology

A novel local impedance algorithm to guide effective pulmonary vein isolation in atrial fibrillation patients: Preliminary experience across different ablation sites from the CHARISMA pilot study

View Full Paper

Ask AI

Bookmark

Key result

Local impedance drop during AF ablation is linked to ~205% higher success odds per 5-point increment.

OR 3.05
95% CI 2.3-4.1
P<0.0001
n=46

Why the study?

A novel technology to measure local impedance has become available, prompting evaluation of relationships between local and generator impedance parameters and procedural success in AF ablation.

Does a novel local impedance algorithm better predict effective lesion formation compared to generator impedance during pulmonary vein isolation in atrial fibrillation patients?

Population

46 AF ablation patients (2219 ablation spots) at 5 Italian centers

Comparison

Local impedance vs generator impedance parameters

Design

Multicenter registry-based pilot study

Authors

LSLuca SegretiElectrophysiology ASAntonio De SimoneElectrophysiology VSVincenzo SchillaciElectrophysiology

Discussion

Member takes

Implication

May support local impedance-guided lesion assessment in AF ablation; leaves open prospective validation versus generator impedance.

Key Points

To assess tissue characteristics and evaluate whether local impedance changes can reliably predict successful lesion formation during pulmonary vein isolation compared to generator impedance.
Analyzed 2,219 ablation spots across 46 consecutive patients undergoing radiofrequency catheter ablation for atrial fibrillation from the multicenter CHARISMA registry at five Italian centers.
Used a radiofrequency ablation catheter equipped with the DIRECTSENSE™ algorithm to monitor local impedance and guide pulmonary vein isolation.
Absolute drops in local impedance were significantly greater than drops in generator impedance following radiofrequency delivery (14 ± 8 Ω vs. 3.7 ± 5 Ω, p < 0.0001).
Every 5-point increment in local impedance drop strongly predicted successful ablation (OR = 3.05, 95% CI: 2.3–4.1, p < 0.0001), whereas generator impedance drops did not differ between successful and unsuccessful sites (3.7 ± 5 vs. 2.8 ± 4 Ω, p = 0.1099).
Complete pulmonary vein isolation was achieved in all 46 patients with no steam pops or major procedural complications.

Study Design

Type

Observational (n=46)

Multicenter

Yes

Structured PICO

Does a novel local impedance algorithm better predict effective lesion formation compared to generator impedance during pulmonary vein isolation in atrial fibrillation patients?

Population

46 patients undergoing atrial fibrillation ablation at five Italian centers, with 2219 ablation spots analyzed.

Exposure

Radiofrequency ablation guided by a novel local impedance algorithm to measure local impedance and guide ablation.

Comparator

Generator impedance parameters (within-spot comparison).

Outcome

Effective lesion formation (successful ablation) and pulmonary vein isolation.surrogate

Main Result

Odds Ratio: 3.05 (95% CI 2.3–4.1)

p-value: p=<0.0001

The magnitude of local impedance drop is a significantly better predictor of effective lesion formation than generator impedance drop during radiofrequency ablation for atrial fibrillation.

Cite This Study

synapsesocial.com/papers/6aa5f32e246eab12a27f395c https://doi.org/10.1111/jce.14647

Also Consider

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

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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