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Contact force and impedance decrease during ablation depends on catheter location and orientation: insights from pulmonary vein isolation using a contact force-sensing catheter

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Abstract

Purpose

Contact force (CF) sensing during radiofrequency (RF) ablation allows controlling lesion size. The aim of this study was to analyze the impact of catheter tip location and orientation on the association of CF and impedance decrease.

Methods

We retrospectively analyzed RF applications from 32 patients undergoing catheter ablation for paroxysmal atrial fibrillation using a force-sensing catheter and 3D mapping system. CF, catheter location and orientation relative to the tissue during ablation as well as the absolute impedance decrease during the first 20 s of ablation as a surrogate for lesion effectiveness were analyzed for 791 RF applications.

Results

While a higher CF was achieved around the right pulmonary veins (12.5 vs. 11.4 g, p = 0.045), a lower median absolute impedance decrease within the first 20 s was seen around the right veins compared to the left veins (9.3 vs. 10.2 Ω, p = 0.02). With different catheter orientations relative to the tissue, higher CF and impedance decrease was seen when the catheter was orientated parallel or oblique to the tissue (30°–145°) as compared perpendicularly (0–30°) with a median CF of 13.2 vs. 8.0 g (p < 0.001) and a median impedance decrease during the first 20 s of 11 vs. 7 Ω (p < 0.001). Importantly, achieved CF, baseline impedance, catheter orientation and location all independently predicted the initial absolute and relative impedance decrease in a multivariable linear regression model (p < 0.05).

Conclusions

The effectiveness of RF ablation lesions, as assessed by the initial impedance decrease, is not only dependent on the achieved catheter CF but also on catheter orientation and location.

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Conflict of interest

Sven Knecht, Tobias Reichlin and Beat Schaer have no conflict of interest. Nikola Pavlovic is supported by an educational grant of the EHRA. Stefan Osswald is a speaker of Bureau for Medtronic, Boston Scientific, Biotronik and St. Jude Medical received unrestricted grants from Medtronic, Boston Scientific, Biotronik and St. Jude Medical. Christian Sticherling is a member of Medtronic Advisory Board Europe and received educational grants from Biosense Webster and Biotronik. Michael Kühne received educational grants from Biosense Webster, proctor for Medtronic and a speaker of Bureau for Boston Scientific, St. Jude Medical and Biotronik.

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    Authors and Affiliations

    1. Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland

      Sven Knecht, Tobias Reichlin, Nikola Pavlovic, Beat Schaer, Stefan Osswald, Christian Sticherling & Michael Kühne

    2. Cardiovascular Research Institute Basel, Basel, Switzerland

      Sven Knecht, Tobias Reichlin, Beat Schaer, Stefan Osswald, Christian Sticherling & Michael Kühne

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    1. Sven Knecht
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    2. Tobias Reichlin
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    Correspondence to Sven Knecht.

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    Sven Knecht and Tobias Reichlin contributed equally to this work.

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    Knecht, S., Reichlin, T., Pavlovic, N. et al. Contact force and impedance decrease during ablation depends on catheter location and orientation: insights from pulmonary vein isolation using a contact force-sensing catheter. J Interv Card Electrophysiol 43, 297–306 (2015). https://doi.org/10.1007/s10840-015-0002-8

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    • DOI: https://doi.org/10.1007/s10840-015-0002-8

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