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Impedance mapping with constant contact force on 3D electroanatomic map to characterize tissues at pulmonary veno-atrial junction

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Abstract

Purpose

Generator impedance (Im) mapping with constant contact force (CF) by tip catheter at PV isolation (PVI) was assessed for a proposal of tissue characterization at PV-LA junction (PV-LAJ).

Methods

In this observational, prospective, single-center study, Im mapping at constant CF = 10 g (± 2 g) was performed before PVI at PV-LAJ. PV in-vein, PV ostium (PVos), and antrum (PVan) contours were manually traced based on the 3D electroanatomic map (3DEAM) integrating intracardiac echocardiography and computerized tomography. PVan contour-methods based on Im mapping was defined on 3DEAM as the atrial-like Im contour closest to PVos, and its distance from anatomical PVan contour > 5 mm was assumed as the non-concordance marker between contour and methods.

Results

Sixty-two patients (62 ± 9 years; 43 males) were enrolled, and 244 PV-LAJ were assessed. From in-vein PV to LA and, less prominently, from PVos to PVan and LA, Im showed a unidirectional decrease with highly variable individual-specific distribution and values. PVan non-concordance was found in 59/665 segments (8.8%), 18% of PV-LAJs, and 53% of pts; it prevailed in superior PV-LAJ and measured on average 7.2 ± 1.1 mm. Im decrease patterns and non-concordance were not associated with any clinical or anatomical feature, including PV dimensions and shape.

Conclusions

Im mapping of LA-PVJ at constant CF added to 3DEAM may consistently track the tissue transition from PV to LA. PVan identified by Im was often located more toward LA than the 3D anatomical PVan, particularly in LSPV, suggesting the potential advantage of avoiding ablation of venous-like tissue. Im mapping can deserve further investigation for target characterization at LA-PVJ.

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References

  1. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2018;20:157–208.

    Article  Google Scholar 

  2. Edriss H, Denega T, Test V, Nugent K. Pulmonary vein stenosis complicating radiofrequency catheter ablation for atrial fibrillation: a literature review. Respir Med. 2016;117:215–22.

    Article  Google Scholar 

  3. Teunissen C, Velthuis BK, Hassink RJ, van der Heijden JF, Vonken EPA, Clappers N, et al. Incidence of pulmonary vein stenosis after radiofrequency catheter ablation of atrial fibrillation. JACC Clin Electrophysiol. 2017;3:589–98.

    Article  Google Scholar 

  4. Lang CC, Gugliotta F, Santinelli V, Mesas C, Tomita T, Vicedomini G, et al. Endocardial impedance mapping during circumferential pulmonary vein ablation of atrial fibrillation differentiates between atrial and venous tissue. Heart Rhythm. 2006;3:171–8.

    Article  Google Scholar 

  5. Pedrote A, Arana-Rueda E, García-Riesco L, Jiménez-Velasco A, Sánchez-Brotons J, Arizón-Muñoz JM, et al. Three-dimensional impedance mapping as an aid to circumferential pulmonary vein isolation in paroxysmal atrial fibrillation. Rev Esp Cardiol. 2009;62:315–9.

    Article  Google Scholar 

  6. Makimoto H, Lin T, Rillig A, Metzner A, Wohlmuth P, Arya A, et al. In vivo contact force analysis and correlation with tissue impedance during left atrial mapping and catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol. 2014;7:46–54.

    Article  Google Scholar 

  7. Kumar S, Morton JB, Lee J, Halloran K, Spence SJ, Gorelik A, et al. Prospective characterization of catheter-tissue contact force at different anatomic sites during antral pulmonary vein isolation. Circ Arrhythm Electrophysiol. 2012;5:1124–9.

    Article  Google Scholar 

  8. Nakagawa H, Kautzner J, Natale A, Peichl P, Cihak R, Wichterle D, et al. 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. Circ Arrhythm Electrophysiol. 2013;6:746–53.

    Article  Google Scholar 

  9. Lacomis JM, Nigginton W, Fuhrman, Schwartzman D, Armfield DR, Pealer KM. Multi-detector row CT of the left atrium and pulmonary veins before radiofrequency catheter ablation for atrial fibrillation. Radiographics. 2003:535–48.

  10. Marom EM, Herndon JE, Kim YH, McAdams HP. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. 2004;230:824–9.

    Article  Google Scholar 

  11. Arentz T, Weber R, Bürkle G, Herrera C, Blum T, Stockinger J, et al. Small or large isolation areas around the pulmonary veins for the treatment of atrial fibrillation? Results from a prospective randomized study. Circulation. 2007;115:3057–63.

    Article  Google Scholar 

  12. Proietti R, Santangeli P, Di Biase L, Joza J, Bernier ML, Wang Y, et al. Comparative effectiveness of wide antral versus ostial pulmonary vein isolation. A systematic review and meta-analysis. Circ Arrhythm Electrophysiol. 2014;7:39–45.

    Article  Google Scholar 

  13. Reichlin T, Michaud GF. Our approach to maximizing the durability of pulmonary vein isolation during a paroxysmal atrial fibrillation ablation procedure. J Cardiovasc Electrophysiol. 2012;23:1272–6.

    Article  Google Scholar 

  14. Vaseghi M, Cesario DA, Valderrabano M, Boyle NG, Ratib O, Finn JP, et al. Impedance monitoring during catheter ablation of atrial fibrillation. Heart Rhythm. 2005;2:914–20.

    Article  Google Scholar 

  15. Scharf C, Sneider M, Case I, Chugh A, Lai SW, Pelosi F Jr, et al. Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography. J Cardiovasc Electrophysiol. 2003;14:150–5.

    Article  Google Scholar 

  16. Knecht S, Reichlin T, Pavlovic N, Schaer B, Osswald S, Sticherling C, 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. 2015;43:297–306.

    Article  Google Scholar 

  17. Kistler PM, Ho SY, Rajappan K, et al. Electrophysiologic and anatomic characterization of sites resistant to electrical isolation during circumferential pulmonary vein ablation for atrial fibrillation: a prospective study. J Cardiovasc Electrophysiol. 2007;18:1282–8.

    Article  Google Scholar 

  18. Ho SH, Cabrera JA, Sanchez-Quintana D. Left atrial anatomy revisited. Circ Arrhythm Electrophysiol. 2012;5:220–8.

    Article  Google Scholar 

  19. Woźniak-Skowerska I, Skowerski M, Wnuk-Wojnar A, Hoffmann A, Nowak S, Gola A, et al. Comparison of pulmonary veins anatomy in patients with and without atrial fibrillation: analysis by multislice tomography. Int J Cardiol. 2011;146:181–5.

    Article  Google Scholar 

  20. Tsao HM, Hu WC, Wu MH, Tai CT, Chang SL, Lin YJ, et al. Characterization of the dynamic function of the pulmonary veins before and after atrial fibrillation ablation using multi-detector computed tomographic images. Int J Cardiovasc Imaging. 2011;27:1049–58.

    Article  Google Scholar 

  21. Buist TJ, Gal P, Ottervanger JP, Smit JJ, Ramdat Misier AR, Delnoy PP, et al. Association between pulmonary vein orientation and ablation outcome in patients undergoing multi-electrode ablation for atrial fibrillation. Cardiovasc Comput Tomogr. 2016;10:251–7.

    Article  Google Scholar 

  22. Gebhard C, Krasniqi N, Stähli BE, Klaeser B, Fuchs TA, Ghadri JR, et al. Characterization of pulmonary vein dimensions using high-definition 64-slice computed tomography prior to radiofrequency catheter ablation for atrial fibrillation. Cardiol Res Pract. 2014;2014:179632 1–8.

    Article  Google Scholar 

  23. Fourdrain A, De Dominicis F, Bensussan M, Iquille J, Lafitte S, Michel D, et al. Three-dimensional computed tomography angiography of the pulmonary veins and their anatomical variations: involvement in video-assisted thoracoscopic surgery-lobectomy for lung cancer. Folia Morphol (Warsz). 2017;76:388–93.

    Article  CAS  Google Scholar 

  24. Okumura Y, Watanabe I, Kofune M, Nagashima K, Sonoda K, Mano H, et al. Effect of catheter tip-tissue surface contact on three-dimensional left atrial and pulmonary vein geometries: potential anatomic distortion of 3D ultrasound, fast anatomical mapping, and merged 3D CT-derived images. J Cardiovasc Electrophysiol. 2013;24:259–66.

    Article  Google Scholar 

  25. Spies F, Kühne M, Reichlin T, Osswald S, Sticherling C, Knecht S. A quantitative comparison of the electrical and anatomical definition of the pulmonary vein ostium. Pacing Clin Electrophysiol. 2017;40:1213–7.

    Article  Google Scholar 

  26. Shah D. Electrophysiological evaluation of pulmonary vein isolation. Europace. 2009;11:1423–33.

    Article  Google Scholar 

Download references

Acknowledgments

Authors thank Fabio Ansaloni, MD, radiologist at Ravenna Hospital, for his careful assessment of CT images; Matteo Fioravanti and Francesco Masci, BME, technical specialists at Biosense-Webster Company, for their assistance at EP procedures and for the image preparation; and Gaia Nicoletti, BME at the University of Bologna, for her contribution to data analysis.

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Authors and Affiliations

  1. Electrophysiology Laboratory, Cardiology Unit, S.Maria delle Croci Hospital, Azienda Unità Sanitaria Locale della Romagna, V.le Randi 8, 48121, Ravenna, Italy

    Corrado Tomasi, Alessandro Dal Monte, Maria Selina Argnani, Federica Giannotti & Andrea Rubboli

  2. Department of Electric, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Via dell’Università 50, 47521, Cesena, Italy

    Cristiana Corsi & Stefano Severi

Authors
  1. Corrado Tomasi
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  2. Alessandro Dal Monte
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  3. Maria Selina Argnani
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  4. Cristiana Corsi
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  5. Federica Giannotti
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  7. Andrea Rubboli
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Corrado Tomasi, Alessandro Dal Monte, Cristiana Corsi Selina Argnani, and Stefano Severi. The first draft of the manuscript was written by Corrado Tomasi, Cristiana Corsi, and Stefano Severi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Corrado Tomasi.

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Conflict of interest

C. T. has been a scientific consultant for Boston Scientific Italia and Biotronik Italia. Other authors declare that they have no conflict of interest.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Romagna–CEROM (no.1870; approval date 17/05/2017) and by Institution “Azienda Unità Sanitaria Locale della Romagna,” to which most authors belong (no.1567, date 12/06/2017).

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All participants have given written informed consent to the study before the enrolment.

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Tomasi, C., Dal Monte, A., Argnani, M.S. et al. Impedance mapping with constant contact force on 3D electroanatomic map to characterize tissues at pulmonary veno-atrial junction. J Interv Card Electrophysiol 61, 469–477 (2021). https://doi.org/10.1007/s10840-020-00845-4

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  • DOI: https://doi.org/10.1007/s10840-020-00845-4

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