AUTHOR=Lepillier Antoine , Maggio Ruggero , De Sanctis Valerio , Malacrida Maurizio , Stabile Giuseppe , Zakine Cyril , Champ-Rigot Laure , Anselmino Matteo , Segreti Luca , Dell’Era Gabriele , Garnier Fabien , Mascia Giuseppe , Pandozi Claudio , Dello Russo Antonio , Scaglione Marco , Cosaro Giuseppe , Ferraro Anna , Paziaud Olivier , Maglia Giampiero , Solimene Francesco 

TITLE=Insight into contact force local impedance technology for predicting effective pulmonary vein isolation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1169037

DOI=10.3389/fcvm.2023.1169037

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Highly localized impedance (LI) measurements during atrial fibrillation (AF) ablation have the potential to act as a reliable predictor of the durability of the lesions created.</p></sec><sec><title>Objective</title><p>We aimed to collect data on the procedural parameters affecting LI-guided ablation in a large multicenter registry.</p></sec><sec><title>Methods</title><p>A total of 212 consecutive patients enrolled in the CHARISMA registry and undergoing their first pulmonary vein (PV) isolation for paroxysmal and persistent AF were included.</p></sec><sec><title>Results</title><p>In all, 13,891 radiofrequency (RF) applications of ≥3 s duration were assessed. The first-pass PV isolation rate was 93.3%. A total of 80 PV gaps were detected. At successful ablation spots, baseline LI and absolute LI drop were larger than at PV gap spots (161.4 ± 19 Ω vs. 153.0 ± 13 Ω, <italic>p</italic> &lt; 0.0001 for baseline LI; 22.1 ± 9 Ω vs. 14.4 ± 5 Ω, <italic>p</italic> &lt; 0.0001 for LI drop). On the basis of Receiver operating characteristic curve analysis, the ideal LI drop, which predicted successful ablation, was &gt;21 Ω at anterior sites and &gt;18 Ω at posterior sites. There was a non-linear association between the magnitude of LI drop and contact-force (CF) (<italic>r</italic> = 0.14, 95% CI: 0.13–0.16, <italic>p</italic> &lt; 0.0001) whereas both CF and LI drop were inversely related with delivery time (DT) (−0.22, −0.23 to −0.20, <italic>p</italic> &lt; 0.0001 for CF; −0.27, −0.29 to −0.26, <italic>p</italic> &lt; 0.0001 for LI drop).</p></sec><sec><title>Conclusion</title><p>An LI drop &gt;21 Ω at anterior sites and &gt;18 Ω at posterior sites predicts successful ablation. A higher CF was associated with an increased likelihood of ideal LI drop. The combination of good CF and adequate LI drop allows a significant reduction in RF DT.</p></sec><sec><title>Clinical trial registration</title><p><ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov/" xmlns:xlink="http://www.w3.org/1999/xlink">http://clinicaltrials.gov/</ext-link>, identifier: NCT03793998.</p></sec>