Impedance‐Based Contact Visualization for PulseSelect Pulmonary Vein Isolation: A Single‐Center Feasibility Study

Figures

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  FIGURE 1. Implementation of CI guidance for PS‐PVI. PulseSelect electrodes 1, 3, 5, 7, and 9 were mapped to the five‐electrode pentaspline catheter configuration via jumper cables (Material S1 and Figure S1). The EnSite X system visualized percentage impedance change in real time. Electrodes showing an impedance increase ≥ 25% were highlighted in light blue. ATP–ETP indicates the virtual bipolar electrode formed by two neighboring electrodes. Sites with CI ≥ 25% were manually tagged on the EnSite voltage map and used as real‐time visual feedback during lesion delivery. In the left panel, blue tags indicate the PV orifice and red tags indicate the antral lesion set.

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  FIGURE 2. Representative cases from Group 1 and Group 2. (Left) In Case 5, PVI was performed without CI guidance. A residual lesion at the bottom of the right inferior pulmonary vein was detected only on the unipolar map (> 1.08 mV). The local atrial u‐EGM demonstrated a residual S wave, suggesting a residual intramural lesion. (Right) In Case 45, PVI was performed primarily under CI guidance. Although residual lesions were detected at the carina of the right pulmonary veins and the posterior side of the RSPV, the local atrial u‐EGM demonstrated loss of the S wave, consistent with an acute unipolar morphology associated with transmural lesion formation. Yellow tags indicate CI ≥ 50%, and red tags indicate CI ≥ 25%–< 50%; both were manually confirmed and tagged at each application site. Blue tags indicate applications inside the PVs without numerical recording.

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  FIGURE 3. The distribution of residual u‐EGMs. The distribution of residual u‐EGMs is shown schematically for both pulmonary veins. Residual sites in Groups 1 and 2 are indicated by pink and light blue circles, respectively. In Group 1, all residual electrograms demonstrated terminal S waves on atrial u‐EGMs (shown in black rectangles). In contrast, residual sites in Group 2, shown as crossed light blue circles, showed no terminal S waves on atrial u‐EGMs (shown in the red rectangle).