Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
“All in one”: contact-force and local impedance guided ablation - Safety and feasibility of a novel technology for pulmonary vein isolation
M. A. Gunawardene1, C. Eickholt1, M. Jularic1, R. Ö. Akbulak2, T. Maurer1, J. Hartmann1, O. Anwar1, J. Jezuit1, M. Flindt3, S. Willems1
1Kardiologie, Asklepios Klinik St. Georg, Hamburg; 2Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 3Abteilung für Kardiologie, Asklepios Klinik Nord - Heidberg, Hamburg;

Introduction:Local impedance (LI) at the ablation site has been found to predict lesion formation during radiofrequency (RF) catheter ablation of atrial fibrillation (AF). However, without the information about the actual contact force (CF), the impact of mechanical catheter-tissue coupling on LI changes cannot be fully appreciated. Thus, a small drop in LI can be due to insufficient catheter-tissue contact or poor lesion formation. Recently, a novel catheter design, combining CF- and LI-measurement has been introduced. So far only data from in-vitro and animal models have been reported for this approach.

The aim of this study was to provide a first assessment of safety and feasibility of this novel ablation approach during clinical application in patients undergoing pulmonary vein isolation (PVI) for symptomatic AF.

 

Methods: From 07/2020 to 11/2020, 12 consecutive patients with a history of AF were enrolled. De novo (PVI) was guided by a 3-D-mapping-system measuring CF and LI both integrated in a single ablation catheter tip (IntellaNav StablePointTMOI, Boston Scientific). LI and CF during RF applications were studied.

 

Results: Complete PVI was achieved in all 100% of patients (12/12 patients and 48/48 pulmonary veins). 6/12 patients suffered from paroxysmal and 6/12 from persistent AF. Mean Age was 68.4±10.2 years with a mean CHA2DS2-VASc Score of 2.7±1.7. Total procedure time was 161.7 ± 41.0 minutes and total fluoroscopy time was 12.4 ± 7.4 minutes. No peri-procedural pericardial tamponade, no blood charring at the catheter tip, no stroke and no major groin complications occurred in the study cohort. There was only one minor groin hematoma, not requiring any intervention or treatment. Baseline LI was 143.2 ± 14.2 Ohm(Ω) prior to ablation start.The average CF during RF delivery was 11.8 ± 5.4 grams (g) and the average LI drop during ablation was 14.8 ± 7.9 Ω (n=286 analyzed RF lesions).

 

Conclusion:A novel ablation approach combining contact force and local impedance facilitates safe and effective delivery of RF lesions in patients undergoing pulmonary vein isolation for atrial fibrillation. While acute procedural success was achieved in all cases, future studies to determine long-term success rates will be needed.
https://dgk.org/kongress_programme/jt2021/aP1173.html