Identification of deliberate catheter motion at the left atrial posterior wall during pulmonary vein isolation: Validity of respiratory motion adjustment

Background During automated radiofrequency (RF) annotation-guided pulmonary vein isolation (PVI), respiratory motion adjustment (RMA) is recommended, yet lacks in vivo validation. Methods Following contact force (CF) PVI (continuous RF, 30 W) using general anesthesia and RF annotation-guidance (VISITAG™: force-over-time 100% minimum 1 g; 2 mm position stability; ACCURESP™ RMA “off”) 25 patients, we retrospectively examined settings “on” versus “off” at the left atrial posterior wall (LAPW). Results Respiratory detection occurred eight, permitting offline retrospective comparison of settings. Significant differences LAPW auto-annotation according to setting, with curves displaying catheter position, CF impedance data indicating “best-fit” for “off.” Comparing “off,” respectively: total annotated sites, 82 98; median duration per-site, 13.3 10.6 s (p < 0.0001); time integral 177 130 gs = 0.0002); mean inter-tag distance (ITD), 6.0 4.8 0.002). Considering site 1-to-2 transitions resulting from deliberate movement, 3 concurrent inadvertent 0 g demonstrated 0.6 difference duration. However, 13 movements during constant tissue (ITD range: 2.1–7.0 mm) (mean) site-1 3.7 (range: −1.3 11.3 s): considering multiple measures instability, appropriate indication all. Conclusions importantly delayed identification clinically relevant delivery, rendering auto-annotated display invalid. Operators seeking greater accuracy delivery should avoid use.