Locations of high contact force during left atrial mapping in atrial fibrillation patients

Electrogram amplitude and impedance are poor predictors of electrode-tissue contact force for ablation of atrial fibrillation

Hiroshi Nakagawa, Josef Kautzner, Andrea Natale, Petr Peichl, Robert Cihak, Dan Wichterle, Atsushi Ikeda, Pasquale Santangeli, Luigi Di Biase, Warren M. Jackman

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background-During radiofrequency ablation, high electrode-tissue contact force (CF) is associated with increased risk of steam pop and perforation. The purpose of this study, in patients undergoing ablation of paroxysmal atrial fibrillation, was to: (1) identify factors producing high CF during left atrial (LA) and pulmonary vein mapping; (2) determine the ability of atrial potential amplitude and impedance to predict CF; and (3) explore the feasibility of controlling radiofrequency power based on CF. Methods and Results-A high-density map of LA/pulmonary veins (median 328 sites) was obtained in 18 patients undergoing atrial fibrillation ablation using a 7.5-Fr irrigated mapping/ablation catheter to measure CF. Average CF was displayed on the 3D map. For 5682 mapped sites, CF ranged 1-144 g (median 8.2 g). High CF (≥35 g) was observed at only 118/5682 (2%) sites, clustering in 6 LA regions. The most common high CF site (48/113 sites in 17/18 patients) was located at the anterior/rightward LA roof, directly beneath the ascending aorta (confirmed by merging the CT image and map). Poor relationship between CF and either unipolar amplitude, bipolar amplitude, or impedance was observed. During ablation, radiofrequency power was modulated based on CF. All pulmonary veins were isolated without steam pop, impedance rise, or pericardial effusion. Conclusions-High CF often occurs at anterior/rightward roof, where the ascending aorta provides resistance to the LA. Atrial potential amplitude and impedance are poor predictors of CF. Controlling radiofrequency power based on CF seems to prevent steam pop and impedance rise without loss of lesion effectiveness.

Original languageEnglish (US)
Pages (from-to)746-753
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume6
Issue number4
DOIs
StatePublished - Aug 2013
Externally publishedYes

Fingerprint

Electric Impedance
Atrial Fibrillation
Electrodes
Pulmonary Veins
Steam
Aorta
Catheter Ablation
Pericardial Effusion
Cluster Analysis

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Electrophysiology mapping
  • Radiofrequency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Locations of high contact force during left atrial mapping in atrial fibrillation patients : Electrogram amplitude and impedance are poor predictors of electrode-tissue contact force for ablation of atrial fibrillation. / Nakagawa, Hiroshi; Kautzner, Josef; Natale, Andrea; Peichl, Petr; Cihak, Robert; Wichterle, Dan; Ikeda, Atsushi; Santangeli, Pasquale; Di Biase, Luigi; Jackman, Warren M.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 6, No. 4, 08.2013, p. 746-753.

Research output: Contribution to journalArticle

Nakagawa, Hiroshi ; Kautzner, Josef ; Natale, Andrea ; Peichl, Petr ; Cihak, Robert ; Wichterle, Dan ; Ikeda, Atsushi ; Santangeli, Pasquale ; Di Biase, Luigi ; Jackman, Warren M. / Locations of high contact force during left atrial mapping in atrial fibrillation patients : Electrogram amplitude and impedance are poor predictors of electrode-tissue contact force for ablation of atrial fibrillation. In: Circulation: Arrhythmia and Electrophysiology. 2013 ; Vol. 6, No. 4. pp. 746-753.
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abstract = "Background-During radiofrequency ablation, high electrode-tissue contact force (CF) is associated with increased risk of steam pop and perforation. The purpose of this study, in patients undergoing ablation of paroxysmal atrial fibrillation, was to: (1) identify factors producing high CF during left atrial (LA) and pulmonary vein mapping; (2) determine the ability of atrial potential amplitude and impedance to predict CF; and (3) explore the feasibility of controlling radiofrequency power based on CF. Methods and Results-A high-density map of LA/pulmonary veins (median 328 sites) was obtained in 18 patients undergoing atrial fibrillation ablation using a 7.5-Fr irrigated mapping/ablation catheter to measure CF. Average CF was displayed on the 3D map. For 5682 mapped sites, CF ranged 1-144 g (median 8.2 g). High CF (≥35 g) was observed at only 118/5682 (2{\%}) sites, clustering in 6 LA regions. The most common high CF site (48/113 sites in 17/18 patients) was located at the anterior/rightward LA roof, directly beneath the ascending aorta (confirmed by merging the CT image and map). Poor relationship between CF and either unipolar amplitude, bipolar amplitude, or impedance was observed. During ablation, radiofrequency power was modulated based on CF. All pulmonary veins were isolated without steam pop, impedance rise, or pericardial effusion. Conclusions-High CF often occurs at anterior/rightward roof, where the ascending aorta provides resistance to the LA. Atrial potential amplitude and impedance are poor predictors of CF. Controlling radiofrequency power based on CF seems to prevent steam pop and impedance rise without loss of lesion effectiveness.",
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author = "Hiroshi Nakagawa and Josef Kautzner and Andrea Natale and Petr Peichl and Robert Cihak and Dan Wichterle and Atsushi Ikeda and Pasquale Santangeli and {Di Biase}, Luigi and Jackman, {Warren M.}",
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T1 - Locations of high contact force during left atrial mapping in atrial fibrillation patients

T2 - Electrogram amplitude and impedance are poor predictors of electrode-tissue contact force for ablation of atrial fibrillation

AU - Nakagawa, Hiroshi

AU - Kautzner, Josef

AU - Natale, Andrea

AU - Peichl, Petr

AU - Cihak, Robert

AU - Wichterle, Dan

AU - Ikeda, Atsushi

AU - Santangeli, Pasquale

AU - Di Biase, Luigi

AU - Jackman, Warren M.

PY - 2013/8

Y1 - 2013/8

N2 - Background-During radiofrequency ablation, high electrode-tissue contact force (CF) is associated with increased risk of steam pop and perforation. The purpose of this study, in patients undergoing ablation of paroxysmal atrial fibrillation, was to: (1) identify factors producing high CF during left atrial (LA) and pulmonary vein mapping; (2) determine the ability of atrial potential amplitude and impedance to predict CF; and (3) explore the feasibility of controlling radiofrequency power based on CF. Methods and Results-A high-density map of LA/pulmonary veins (median 328 sites) was obtained in 18 patients undergoing atrial fibrillation ablation using a 7.5-Fr irrigated mapping/ablation catheter to measure CF. Average CF was displayed on the 3D map. For 5682 mapped sites, CF ranged 1-144 g (median 8.2 g). High CF (≥35 g) was observed at only 118/5682 (2%) sites, clustering in 6 LA regions. The most common high CF site (48/113 sites in 17/18 patients) was located at the anterior/rightward LA roof, directly beneath the ascending aorta (confirmed by merging the CT image and map). Poor relationship between CF and either unipolar amplitude, bipolar amplitude, or impedance was observed. During ablation, radiofrequency power was modulated based on CF. All pulmonary veins were isolated without steam pop, impedance rise, or pericardial effusion. Conclusions-High CF often occurs at anterior/rightward roof, where the ascending aorta provides resistance to the LA. Atrial potential amplitude and impedance are poor predictors of CF. Controlling radiofrequency power based on CF seems to prevent steam pop and impedance rise without loss of lesion effectiveness.

AB - Background-During radiofrequency ablation, high electrode-tissue contact force (CF) is associated with increased risk of steam pop and perforation. The purpose of this study, in patients undergoing ablation of paroxysmal atrial fibrillation, was to: (1) identify factors producing high CF during left atrial (LA) and pulmonary vein mapping; (2) determine the ability of atrial potential amplitude and impedance to predict CF; and (3) explore the feasibility of controlling radiofrequency power based on CF. Methods and Results-A high-density map of LA/pulmonary veins (median 328 sites) was obtained in 18 patients undergoing atrial fibrillation ablation using a 7.5-Fr irrigated mapping/ablation catheter to measure CF. Average CF was displayed on the 3D map. For 5682 mapped sites, CF ranged 1-144 g (median 8.2 g). High CF (≥35 g) was observed at only 118/5682 (2%) sites, clustering in 6 LA regions. The most common high CF site (48/113 sites in 17/18 patients) was located at the anterior/rightward LA roof, directly beneath the ascending aorta (confirmed by merging the CT image and map). Poor relationship between CF and either unipolar amplitude, bipolar amplitude, or impedance was observed. During ablation, radiofrequency power was modulated based on CF. All pulmonary veins were isolated without steam pop, impedance rise, or pericardial effusion. Conclusions-High CF often occurs at anterior/rightward roof, where the ascending aorta provides resistance to the LA. Atrial potential amplitude and impedance are poor predictors of CF. Controlling radiofrequency power based on CF seems to prevent steam pop and impedance rise without loss of lesion effectiveness.

KW - Atrial fibrillation

KW - Catheter ablation

KW - Electrophysiology mapping

KW - Radiofrequency

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