Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation
Objectives This analysis was performed to evaluate the transition of local impedance (LI) drop during pulmonary vein isolation (PVI) to durable block and mature lesion formation based on 3-month mapping procedures. Background A radiofrequency catheter measuring LI has been shown to be effective for...
| Autores: | , , , , , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2022 |
| País: | España |
| Institución: | Universidad de Navarra |
| Repositorio: | Dadun. Depósito Académico Digital de la Universidad de Navarra |
| Idioma: | inglés |
| OAI Identifier: | oai:dadun.unav.edu:10171/112552 |
| Acceso en línea: | https://hdl.handle.net/10171/112552 |
| Access Level: | acceso abierto |
| Palabra clave: | atrial fibrillation local impedance radiofrequency ablation |
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oai:dadun.unav.edu:10171/112552 |
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Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial FibrillationGarcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5bRamos, P. (Pablo)|||/items/0047fadc-6917-443f-a250-f891836a548fLuik, A. (Armin)|||/items/e29a5010-8600-446c-81dc-47464a5e3cd7Sulkin, M. (Matthew)|||/items/029835fe-c9bb-480c-bf8f-aa48ac3bf68eGutbrod, S.R. (Sarah R.)|||/items/8b6c0f8e-174d-41cf-88f6-f0945a94e9f7Oesterlein, T. (Tobias)|||/items/8a1ee766-d159-4062-b2cb-d810c8923602Laughner, J. (Jacob)|||/items/5740a69c-a85f-45dc-b7c5-5cbdfe919291Richards, E. (Elizabeth)|||/items/55757bd4-4e17-4254-9e0d-3cb7c3386646Meyer, C. (Christian)|||/items/ff45fa87-c1e4-4619-bb85-27a0daf3f4a2Yue, A. (Arthur)|||/items/e2251ba1-38d4-48d3-93fa-d0ba26b9aff4Ullah, W. (Waqas)|||/items/35344463-9eb3-40f0-b24f-80bdc7e735fdShepherd, E. (Ewen)|||/items/dceaac9b-3355-4cf3-a7d2-bfdc50cb7e0aDas, M. (Moloy)|||/items/b1ebf0b0-107a-4edf-a2df-50cd922124f8atrial fibrillationlocal impedanceradiofrequency ablationObjectives This analysis was performed to evaluate the transition of local impedance (LI) drop during pulmonary vein isolation (PVI) to durable block and mature lesion formation based on 3-month mapping procedures. Background A radiofrequency catheter measuring LI has been shown to be effective for performing PVI in patients with paroxysmal atrial fibrillation. Previous analysis has demonstrated LI drop to be predictive of pulmonary vein segment conduction block during an atrial fibrillation ablation procedure. Methods Fifty-eight patients who had undergone LI-blinded de novo PVI returned for a 3-month mapping procedure. PVI ablation circles were divided into 16 anatomic segments for classification (durable block or gap), and the median LI drop within segments with an interlesion distance of ≤6 mm was compared. A total of 51 data sets met the criteria for segmental analysis of LI performance. Results At the 3-month procedure, PV connection was confirmed in at least 1 PV segment in 35 of the included patients. LI drop outperformed generator impedance drop as a predictor of durable conduction block (area under the receiver-operating characteristic curve: 0.79 vs 0.68; P = 0.003). Optimal LI drops were identified by left atrial region (anterior/superior: 16.9 Ω [sensitivity: 69.1%; specificity: 85.0%; positive predictive value for durable conduction block: 97.7%]; posterior/inferior:14.2 Ω [sensitivity: 73.8%; specificity: 78.3%; positive predictive value: 96.9%]). Starting LI before radiofrequency (RF) application was significantly different among healthy, gap, and mature scar tissue and was also a contributing factor to achieving an optimal LI drop (85.2% of RF applications with a starting LI of ≥110 Ω achieved the optimal regional drop or greater). Conclusions LI drop is predictive of durable PV segment isolation. Preablation starting LI is associated with the magnitude of LI drop. These findings suggest that a regional approach to RF ablation guided by LI combined with careful interlesion distance control may be beneficial in patients with paroxysmal atrial fibrillation (Electrical Coupling Information From the Rhythmia HDx System and DirectSense Technology in Subjects With Paroxysmal Atrial Fibrillation [LOCALIZE]ElsevierDadun. Depósito Académico Digital Universidad de Navarra20222022-01-0120222022-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10171/112552reponame:Dadun. Depósito Académico Digital de la Universidad de Navarrainstname:Universidad de NavarraInglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:dadun.unav.edu:10171/1125522026-06-21T12:47:57Z |
| dc.title.none.fl_str_mv |
Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation |
| title |
Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation |
| spellingShingle |
Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation Garcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5b atrial fibrillation local impedance radiofrequency ablation |
| title_short |
Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation |
| title_full |
Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation |
| title_fullStr |
Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation |
| title_full_unstemmed |
Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation |
| title_sort |
Local Impedance Drop Predicts Durable Conduction Block in Patients With Paroxysmal Atrial Fibrillation |
| dc.creator.none.fl_str_mv |
Garcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5b Ramos, P. (Pablo)|||/items/0047fadc-6917-443f-a250-f891836a548f Luik, A. (Armin)|||/items/e29a5010-8600-446c-81dc-47464a5e3cd7 Sulkin, M. (Matthew)|||/items/029835fe-c9bb-480c-bf8f-aa48ac3bf68e Gutbrod, S.R. (Sarah R.)|||/items/8b6c0f8e-174d-41cf-88f6-f0945a94e9f7 Oesterlein, T. (Tobias)|||/items/8a1ee766-d159-4062-b2cb-d810c8923602 Laughner, J. (Jacob)|||/items/5740a69c-a85f-45dc-b7c5-5cbdfe919291 Richards, E. (Elizabeth)|||/items/55757bd4-4e17-4254-9e0d-3cb7c3386646 Meyer, C. (Christian)|||/items/ff45fa87-c1e4-4619-bb85-27a0daf3f4a2 Yue, A. (Arthur)|||/items/e2251ba1-38d4-48d3-93fa-d0ba26b9aff4 Ullah, W. (Waqas)|||/items/35344463-9eb3-40f0-b24f-80bdc7e735fd Shepherd, E. (Ewen)|||/items/dceaac9b-3355-4cf3-a7d2-bfdc50cb7e0a Das, M. (Moloy)|||/items/b1ebf0b0-107a-4edf-a2df-50cd922124f8 |
| author |
Garcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5b |
| author_facet |
Garcia-Bolao, I. (Ignacio)|||/items/c29cdf3e-401f-4293-b138-6843f6f6bf5b Ramos, P. (Pablo)|||/items/0047fadc-6917-443f-a250-f891836a548f Luik, A. (Armin)|||/items/e29a5010-8600-446c-81dc-47464a5e3cd7 Sulkin, M. (Matthew)|||/items/029835fe-c9bb-480c-bf8f-aa48ac3bf68e Gutbrod, S.R. (Sarah R.)|||/items/8b6c0f8e-174d-41cf-88f6-f0945a94e9f7 Oesterlein, T. (Tobias)|||/items/8a1ee766-d159-4062-b2cb-d810c8923602 Laughner, J. (Jacob)|||/items/5740a69c-a85f-45dc-b7c5-5cbdfe919291 Richards, E. (Elizabeth)|||/items/55757bd4-4e17-4254-9e0d-3cb7c3386646 Meyer, C. (Christian)|||/items/ff45fa87-c1e4-4619-bb85-27a0daf3f4a2 Yue, A. (Arthur)|||/items/e2251ba1-38d4-48d3-93fa-d0ba26b9aff4 Ullah, W. (Waqas)|||/items/35344463-9eb3-40f0-b24f-80bdc7e735fd Shepherd, E. (Ewen)|||/items/dceaac9b-3355-4cf3-a7d2-bfdc50cb7e0a Das, M. (Moloy)|||/items/b1ebf0b0-107a-4edf-a2df-50cd922124f8 |
| author_role |
author |
| author2 |
Ramos, P. (Pablo)|||/items/0047fadc-6917-443f-a250-f891836a548f Luik, A. (Armin)|||/items/e29a5010-8600-446c-81dc-47464a5e3cd7 Sulkin, M. (Matthew)|||/items/029835fe-c9bb-480c-bf8f-aa48ac3bf68e Gutbrod, S.R. (Sarah R.)|||/items/8b6c0f8e-174d-41cf-88f6-f0945a94e9f7 Oesterlein, T. (Tobias)|||/items/8a1ee766-d159-4062-b2cb-d810c8923602 Laughner, J. (Jacob)|||/items/5740a69c-a85f-45dc-b7c5-5cbdfe919291 Richards, E. (Elizabeth)|||/items/55757bd4-4e17-4254-9e0d-3cb7c3386646 Meyer, C. (Christian)|||/items/ff45fa87-c1e4-4619-bb85-27a0daf3f4a2 Yue, A. (Arthur)|||/items/e2251ba1-38d4-48d3-93fa-d0ba26b9aff4 Ullah, W. (Waqas)|||/items/35344463-9eb3-40f0-b24f-80bdc7e735fd Shepherd, E. (Ewen)|||/items/dceaac9b-3355-4cf3-a7d2-bfdc50cb7e0a Das, M. (Moloy)|||/items/b1ebf0b0-107a-4edf-a2df-50cd922124f8 |
| author2_role |
author author author author author author author author author author author author |
| dc.contributor.none.fl_str_mv |
Dadun. Depósito Académico Digital Universidad de Navarra |
| dc.subject.none.fl_str_mv |
atrial fibrillation local impedance radiofrequency ablation |
| topic |
atrial fibrillation local impedance radiofrequency ablation |
| description |
Objectives This analysis was performed to evaluate the transition of local impedance (LI) drop during pulmonary vein isolation (PVI) to durable block and mature lesion formation based on 3-month mapping procedures. Background A radiofrequency catheter measuring LI has been shown to be effective for performing PVI in patients with paroxysmal atrial fibrillation. Previous analysis has demonstrated LI drop to be predictive of pulmonary vein segment conduction block during an atrial fibrillation ablation procedure. Methods Fifty-eight patients who had undergone LI-blinded de novo PVI returned for a 3-month mapping procedure. PVI ablation circles were divided into 16 anatomic segments for classification (durable block or gap), and the median LI drop within segments with an interlesion distance of ≤6 mm was compared. A total of 51 data sets met the criteria for segmental analysis of LI performance. Results At the 3-month procedure, PV connection was confirmed in at least 1 PV segment in 35 of the included patients. LI drop outperformed generator impedance drop as a predictor of durable conduction block (area under the receiver-operating characteristic curve: 0.79 vs 0.68; P = 0.003). Optimal LI drops were identified by left atrial region (anterior/superior: 16.9 Ω [sensitivity: 69.1%; specificity: 85.0%; positive predictive value for durable conduction block: 97.7%]; posterior/inferior:14.2 Ω [sensitivity: 73.8%; specificity: 78.3%; positive predictive value: 96.9%]). Starting LI before radiofrequency (RF) application was significantly different among healthy, gap, and mature scar tissue and was also a contributing factor to achieving an optimal LI drop (85.2% of RF applications with a starting LI of ≥110 Ω achieved the optimal regional drop or greater). Conclusions LI drop is predictive of durable PV segment isolation. Preablation starting LI is associated with the magnitude of LI drop. These findings suggest that a regional approach to RF ablation guided by LI combined with careful interlesion distance control may be beneficial in patients with paroxysmal atrial fibrillation (Electrical Coupling Information From the Rhythmia HDx System and DirectSense Technology in Subjects With Paroxysmal Atrial Fibrillation [LOCALIZE] |
| publishDate |
2022 |
| dc.date.none.fl_str_mv |
2022 2022-01-01 2022 2022-01-01 |
| dc.type.none.fl_str_mv |
journal article http://purl.org/coar/resource_type/c_6501 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
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article |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/10171/112552 |
| url |
https://hdl.handle.net/10171/112552 |
| dc.language.none.fl_str_mv |
Inglés eng |
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Inglés |
| language |
eng |
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open access http://purl.org/coar/access_right/c_abf2 |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 |
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openAccess |
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application/pdf |
| dc.publisher.none.fl_str_mv |
Elsevier |
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Elsevier |
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reponame:Dadun. Depósito Académico Digital de la Universidad de Navarra instname:Universidad de Navarra |
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Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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Dadun. Depósito Académico Digital de la Universidad de Navarra |
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