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Prospective evaluation of local impedance drop to guide left atrial posterior wall ablation with high power

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Abstract

Background

Local impedance (LI) drop predicts acute conduction block during pulmonary vein isolation (PVI). Whether the LI drop predicts also the achievement of left atrial posterior wall isolation (LAPWI) in persistent atrial fibrillation (PersAF) patients is unknown. We evaluated the efficacy and the safety of LI drop-guided LAPW ablation by using high power (50 watts) and investigated the impact of ablation parameters on the LI drop.

Methods

We included consecutive PersAF patients underwent PVI and both roof line and floor line completion to achieve LAPWI with a novel contact force (CF)- and LI-featured catheter (IntellaNAV Stablepoint™). For each radiofrequency (RF) application, we targeted a LI drop of 25 ohms.

Results

Out of 30 patients, first-pass floor line block was achieved in 26 (87%) and first-pass roof line block in 17 (57%), resulting in first-pass LAPWI in 14 patients (47%). After touch-up ablations, LAPWI was achieved in 28 patients (93%) with endocardial ablation only. No procedural nor 1-month complications occurred. Overall, 877 RF applications were delivered: 787 ablation tags (89%) were associated with acute conduction block, while 90 (11%) were located at sites of acute gaps in either the roof or floor line. LI drop values were greater at segments with acute block than those with gaps (p < 0.001). At multivariable analysis, only LI drop and RF time remained independently associated with the acute block (p < 0.001; p = 0.001).

Conclusions

LI drop-guided LAPWI at a fixed power of 50 W was effective and did not lead to complications. LI drop was the most important predictor of acute conduction block.

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Authors and Affiliations

  1. Clinica Montevergine, Mercogliano, Avellino, Italy

    Francesco Solimene, Vincenzo Schillaci, Giuseppe Stabile, Gergana Shopova, Alberto Arestia, Armando Salito & Teresa Strisciuglio

  2. Anthea Hospital, Bari, Italy

    Giuseppe Stabile

  3. Boston Scientific, Milan, Italy

    Francesco Maddaluno & Maurizio Malacrida

  4. University of Naples Federico II, Naples, Italy

    Teresa Strisciuglio

Authors
  1. Francesco Solimene
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  2. Vincenzo Schillaci
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  3. Giuseppe Stabile
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  4. Gergana Shopova
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  5. Alberto Arestia
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  6. Armando Salito
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  7. Francesco Maddaluno
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  8. Maurizio Malacrida
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  9. Teresa Strisciuglio
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Contributions

Concept/design: Soliemen F, Stabile G, Schillaci V, Strisciuglio T; data analysis/interpretation: Maddaluno F, Malacrida M, Solimene F, Stabile G; drafting article: Strisciuglio T, Schillaci V, Salito A, Shopova G; critical revision of article: Arestia A, Shopova G, Salito A; approval of article: Strisciuglio T, Stabile G, Solimene F, Schillaci V; statistics: Maddaluno M, Malacrida M, Solimene F; data collection: Shopova G, Schillaci V, Arestia A, Salito A.

Corresponding author

Correspondence to Francesco Solimene.

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Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

M. Malacrida, F. Maddaluno are employees of Boston Scientific. The other authors have no conflicts of interest to declare.

Ethical approval

Approval was obtained from the ethic committee of Clinica Montevergine, Mercogliano, Italy. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Solimene, F., Schillaci, V., Stabile, G. et al. Prospective evaluation of local impedance drop to guide left atrial posterior wall ablation with high power. J Interv Card Electrophysiol 65, 675–684 (2022). https://doi.org/10.1007/s10840-022-01317-7

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  • DOI: https://doi.org/10.1007/s10840-022-01317-7

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