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Simultaneous assessment of contact pressure and local electrical coupling index using robotic navigation

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Abstract

Purpose

Contact with cardiac tissue is a determinant of lesion efficacy during atrial fibrillation (AF) ablation. The Sensei®X Robotic Catheter System (Hansen Medical, CA) has been validated for contact force sensing. The electrical coupling index (ECI) from the EnSite Contact™ system (St. Jude Medical, MN) has been validated as an indicator of tissue contact. We aimed at analyzing ECI behavior during radiofrequency (RF) pulses maintaining a stable contact through the robotic navigation contact system.

Methods

In 15 patients (age, 59 ± 12) undergoing AF ablation, pulmonary vein (PV) isolation was guided by the Sensei®X System, employing the Contact™ catheter.

Results

During the procedure, we assessed ECI changes associated with adequate contact based on the IntelliSense® force-sensing technology (Hansen Medical, CA. Baseline contact (27 ± 8 g/cm2) ECI value was 99 ± 13, whereas ECI values in a noncontact site (0 g/cm2) and in a light contact site (1–10 g/cm2) were respectively 66 ± 12 and 77 ± 10 (p < 0.0001). Baseline contact ECI values were not different depending on AF presentation (paroxysmal AF, 98 ± 9; persistent AF, 100 ± 9) or on cardiac rhythm (sinus rhythm, 97 ± 7; AF,101 ± 10). In all PVs, ECI was significantly reduced during and after ablation (ECI during RF, 56 ± 15; ECI after RF, 72 ± 16; p < 0.001). A mean reduction of 32.2 % during RF delivery and 25.4 % immediately after RF discontinuation compared with baseline ECI was observed.

Conclusions

Successful PV isolation is associated with a significant decrease in ECI of at least 20 %. This may be used as a surrogate marker of effective lesion in AF ablation.

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Acknowledgments

The authors wish to thank Eng. Elena Romanelli, Pasquale De Iuliis, Enrico Romano, and Antonio Mininno (St. Jude Medical) for their technical support in NavX mapping and data analysis and Eng Guido Panfili (Abmedica) and Matteo Vernich (Hansen Medical) for technical support.

Disclosures

Antonio Dello Russo, Michela Casella, Fabrizio Bologna, Osama Al-Nono, Daniele Colombo, Viviana Biagioli, Pasquale Santangeli, Martina Zucchetti, Benedetta Majocchi, Vittoria Marino, Joseph J Gallinghouse have no relationships or conflicts to disclose. Gaetano Fassini serves as consultant for Medtronic and Biosense-Webster. Luigi Di Biase serves as consultant for Hansen Medical and Biosense-Webster. Andrea Natale has received compensation for belonging to the speakers’ bureau for St. Jude Medical, Boston Scientific, Medtronic, and Biosense-Webster. Dr. Natale is a consultant for Biosense-Webster. Claudio Tondo serves as member of the Advisory Board of Medtronic and is also a consultant for and receives lecture fees from St. Jude Medical

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Authors and Affiliations

  1. Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy

    Antonio Dello Russo, Gaetano Fassini, Michela Casella, Fabrizio Bologna, Osama Al-Nono, Daniele Colombo, Viviana Biagioli, Martina Zucchetti, Benedetta Majocchi, Vittoria Marino & Claudio Tondo

  2. Texas Cardiac Arrhythmia Institute at St David’s Medical Center, Austin, TX, USA

    Pasquale Santangeli, Luigi Di Biase, Joseph J. Gallinghouse & Andrea Natale

Authors
  1. Antonio Dello Russo
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  2. Gaetano Fassini
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  3. Michela Casella
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  9. Luigi Di Biase
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  13. Joseph J. Gallinghouse
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  14. Andrea Natale
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  15. Claudio Tondo
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Corresponding author

Correspondence to Michela Casella.

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Dello Russo, A., Fassini, G., Casella, M. et al. Simultaneous assessment of contact pressure and local electrical coupling index using robotic navigation. J Interv Card Electrophysiol 40, 23–31 (2014). https://doi.org/10.1007/s10840-014-9882-2

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  • DOI: https://doi.org/10.1007/s10840-014-9882-2

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