scholarly journals Transmural unipolar electrogram morphology is achieved within 7s at the posterior left atrial wall during pulmonary vein isolation: VISITAG™ Module-based lesion assessment during radiofrequency ablation

2017 ◽  
Author(s):  
David R. Tomlinson ◽  
Madison Myles ◽  
Kara N. Stevens ◽  
Adam J. Streeter
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Left Atrial ◽  
Biological Effects ◽  
Posterior Wall ◽  
Morphology Change ◽  
Atrial Ablation ◽  
Left Atrial Posterior ◽  
Unipolar Electrogram

AbstractAimsTo assess the occurrence of a histologically validated measure of transmural (TM) atrial ablation – pure R unipolar electrogram (UE) morphology change – at first-ablated left atrial posterior wall (LAPW) sites during contact force (CF)-guided pulmonary vein isolation (PVI).Methods and resultsExported VISITAG™ Module and CARTOREPLAY™ (Biosense Webster Inc.) UE morphology data was retrospectively analysed in 23 consecutive patients undergoing PVI under general anaesthesia. PVI without spontaneous / dormant recovery was achieved in all, employing 16.3[3.2] minutes (mean [SD]) of temperature-controlled RF at 30W. All first-ablated LAPW sites demonstrated RS UE morphology pre-ablation, with RF-induced pure R UE morphology change in 98%. Time to pure R UE morphology was significantly shorter at left-sided LAPW sites (4.9[2.1] s versus 6.7[2.5] s; p=0.02), with significantly greater impedance drop (median 13.5Ω versus 9.9Ω; p=0.003). Importantly, neither the first-site RF duration (14.9 versus 15.0s) nor the maximum ablation catheter tip distance moved (during RF) were significantly different, yet the mean CF was significantly higher at right-sided sites (16.5g versus 11.2g; p=0.002). Concurrent impedance and objectively annotated bipolar electrogram (BE) data demonstrated ~6-8Ω impedance drop and ~30% BE decrease at the time of first pure R UE morphology change.ConclusionUsing objective ablation site annotation, TM UE morphology change was typically achieved within 7s at the LAPW, with significantly greater ablative effect evident at left-sided sites. The methodology described in this report represents a novel and scientifically more rigorous foundation towards future research into the biological effects of RF ablation in vivo.Condensed abstractThrough appropriate use of the VISITAG™ Module and CARTOREPLAY™, unipolar electrogram morphology change indicative of histologically confirmed transmural atrial ablation in animal models, was proven to occur typically within 7s, during first-site contact force-guided ablation at the left atrial posterior wall during pulmonary vein isolation.

scholarly journals Assessment of the transmural unipolar electrogram morphology change radius during contact force-guided pulmonary vein isolation using the VISITAG™ Module and CARTOREPLAY™

2018 ◽  
Author(s):  
David R. Tomlinson ◽  
Kara N. Stevens ◽  
Adam J. Streeter
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Posterior Wall ◽  
List Type ◽  
Energy Effect ◽  
Morphology Change ◽  
Atrial Ablation ◽  
Left And Right ◽  
Rf Energy ◽  
Unipolar Electrogram

AbstractAimsTo investigate the radius of transmural (TM) ablation effect at the left atrial posterior wall (LAPW) during contact force (CF)-guided pulmonary vein isolation (PVI), using pure R unipolar electrogram (UE) morphology change – a histologically validated marker of radiofrequency (RF)-induced TM atrial ablation.MethodsFollowing PVI in 24 consecutive patients (30W, continuous RF), VISITAG™ Module and CARTOREPLAY™ (Biosense Webster Inc.) RF and UE data at left and right-sided LAPW annotated sites 1 and 2 were analysed.ResultsAcutely durable PVI without spontaneous / dormant recovery was achieved following 15s and 10-11s RF, at sites 1 and 2, respectively (p<0.0001). At site 1, RS UE morphology was noted pre-ablation, with RF-induced pure R UE morphology change in 47/48 (98%). Left and right-sided second RF site annotation was at 5.8mm and 5.2mm from site 1 respectively (p=0.64), yet immediate pure R UE morphology was noted in 35/48 (73%). For second-annotated sites, 30 demonstrated inter-ablation site transition time ≤17ms; pure R UE morphology was noted at annotation onset in 22/30 (73%), with overall median time to pure R morphology change significantly shorter than at site 1 – 0.0s, versus 4.1s and 5.3s, for left and right-sided first-annotated LAPW sites, respectively (p<0.0001).ConclusionWhen the first and second-annotated LAPW RF sites were within 7mm, 73% second-annotated sites demonstrated immediate pure R UE morphology change. These analyses support a paradigm of shorter RF duration at immediately adjacent sites during continuous RF application, and may usefully inform the further development of “tailored” approaches towards CF-guided PVI.What’s known?The VISITAG™ Module and CARTOREPLAY™ permit investigations into the tissue effects of RF energy delivery in vivo, via objective annotation methodology and retrospective evaluation of histologically validated unipolar electrogram (UE) criteria for transmural (TM) atrial ablation.Greater RF energy effect is seen at left compared to right-sided first-annotated left atrial posterior wall (LAPW) sites during pulmonary vein isolation (PVI).What’s new?Following ∼15s RF delivery at first-annotated LAPW sites and aiming for ≤6mm inter-ablation site distance during continuous RF delivery, 73% second-annotated sites demonstrated immediate TM UE morphology change.At second-annotated sites, ∼10s RF resulted in acutely durable PVI in all. Greater left-sided RF energy effect was observed, not explained by differences in RF duration, mean CF or catheter position stability.The radius of TM RF effect may be determined at the LAPW following CF and VISITAG™ Module-guided PVI.

scholarly journals Mechanistic insights into heterogeneous radiofrequency ablation effects at the left atrial posterior wall during pulmonary vein isolation

2019 ◽  
Author(s):  
David R. Tomlinson
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Posterior Wall ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Rf Ablation ◽  
Overdrive Pacing ◽  
Left Atrial Posterior ◽  
Tissue Motion

AbstractBackgroundIndependent investigations demonstrate greater radiofrequency (RF) ablation effects at left- sided left atrial posterior wall (LAPW) sites.ObjectiveTo investigate mechanisms underlying RF ablation heterogeneity during contact-force (CF) and VISITAG™ Module (Biosense Webster)-guided pulmonary vein isolation (PVI).MethodsConsecutive patients undergoing PVI during atrial overdrive pacing comprised 2 cohorts: intermittent positive pressure ventilation (IPPV, 14-16/min, 6-8ml/kg); high frequency jet ventilation (HFJV, 150/min, Monsoon III, Acutronic). Temperature-controlled (17ml/min, 48°C) RF data was retrospectively assessed at first-annotated (target 15s) LAPW sites: 30W during IPPV; 20W at left-sided sites during HFJV.ResultsTwenty-five and 15 patients underwent PVI during IPPV and HFJV, respectively. During IPPV, left versus right-sided median impedance drop (ImpD) was 13.6Ω versus 9.9Ω (p<0.0001) respectively and mean time to pure R unipolar electrogram (UE) morphology change 4.9s versus 6.7s (p=0.007) respectively. During HFJV, ImpD was greater at left-sided sites (9.7Ω versus 7.4Ω, p=0.21) and time to pure R UE significantly shorter: 4.3s versus 6.1s (p=0.02). Minimum case impedance subtracted from pre-RF baseline impedance (BI) generated site-specific ΔBI. Left-sided sites demonstrated significantly greater ΔBI, correlating strongly with Ln(ImpD) – IPPV r=0.84 (0.65 – 0.93), HFJV r=0.77 (0.35 – 0.93).At right-sided sites, ΔBI and Ln(ImpD) were without correlation during IPPV, but correlation was modest during HFJV (r=0.54, -0.007 – 0.84).ConclusionsΔBI may usefully indicate catheter-tissue contact surface area (SA). Consequently, greater left-sided LAPW RF effect may result from greater contact SA and in-phase catheter-tissue motion; HFJV may reduce right-sided out-of-phase catheter-tissue motion. Modifying RF delivery based on ΔBI may improve PVI safety and efficacy.

scholarly journals The relationship between oesophageal heating during left atrial posterior wall ablation and the durability of pulmonary vein isolation

EP Europace ◽  
2017 ◽  
Vol 19 (10) ◽  
pp. 1664-1669 ◽  
Author(s):  
V Nam Tran ◽  
Shigeki Kusa ◽  
Jeffrey Smietana ◽  
Wen-Chi Tsai ◽  
Kabir Bhasin ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Posterior Wall ◽  
The Relationship ◽  
Left Atrial Posterior

Impact of the size of non-ablated left atrial posterior wall area on outcomes after extensive encircling pulmonary vein isolation

2021 ◽  
Author(s):  
Shingo Yoshimura ◽  
Kenichi Kaseno ◽  
Kohki Kimura ◽  
Wataru Sasaki ◽  
Yoshinori Okazaki ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Left Atrial ◽  
Posterior Wall ◽  
Wall Area ◽  
Left Atrial Posterior
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