Local impedance drop guided versus lesion size index guided pulmonary vein isolation: acute success and reconnections

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Insufficient lesion depth and discontinuity lines are reasons for reconnections after point-by-point radiofrequency pulmonary vein isolation (PVI). Different technologies have shown to be useful prediction effective lesions. Measurement the magnitude local tissue impedance drop (LID) calculation size index (LSI) based on monitoring contact force examples corresponding technologies. Purpose To compare acute efficacy LID guided with LSI PVI. Methods In this retrospective study we compared two groups patients who underwent PVI treatment atrial fibrillation. LID-guided group (n=35) energy was delivered using IntellaNav MiFi (Boston Scientific, MA, USA) ablation catheter. Ablation terminated when reached a plateau (Figure A). LSI-guided (n=31) lesions were created Tacticath (Abbott, catheter until target in each point (LSI=5 anterior LSI=4 posterior segments respectively, Figure B). The inter-lesion distance <6 mm power 40 W 30W used both groups. A gap-map touch-up performed along line if first pass did not occur, or case an reconnection 20 min waiting time. post hoc analysis initial levels system impedance, average included models predicting PV gaps. Results All PVs successfully isolated by encirclement ipsilateral veins significantly longer median time 30(IQR:27-35) as group:25 (IQR:21-31) (p=0.035). First-pass achieved 97 out 132(73%) circles (LID-guided:43 70 [61%] vs LSI-guided:54 62 [87%] circles, p=0.002). Acute occurred 14 132 (11%) (LID-guided:9 [13%] LSI-guided: 5 [8%] p=0.54, C). Overall, more had gaps (26 35[74%] 13 31[42%] p=0.016). LID<9.7Ω only predictive parameter gap (sensitivity=96.4%, specificity=67%). Conclusions resulted successful shorter fewer LID-guided. This reflects nature anticipating quality catheter-tissue interface before application, which is possible impedance-only approach.