Abstract
Introduction: A novel ablation catheter that can measure local impedance
(LI) was recently launched. We aimed to explore target LI measurements
at each radiofrequency application (RFA) for creating sufficient
ablation lesions during pulmonary vein (PV) isolation. Methods: This
prospective study included 15 consecutive patients scheduled to undergo
an initial ablation of paroxysmal atrial fibrillation (AF).
Circumferential ablation around both ipsilateral PVs was performed using
a 4-mm irrigated ablation catheter with an LI sensor. Point-by-point
ablation was used with a 4-mm inter-ablation-point distance. Operators
were blinded to LI measurements during the procedure. Creation of
sufficient ablation lesions was assessed by the absence of a conduction
gap. Results: After first-pass encircling PV antrum ablation, left
atrium to PV conduction remained in 12 of 30 (40%) ipsilateral PVs.
Mapping using the mini-basket catheter identified 48 ablation points
through which the propagation wave entered the PV. At ablation points
with a gap, the LI drop during RFA was half that at points without a gap
(12 ± 7 vs. 23 ± 12 ohm, p<0.001). The GI drop did not differ
between ablation points with and without a gap (12 ± 7 vs. 14 ± 10 ohm,
p=0.10). An LI drop of 15 ohm predicted sufficient lesion formation
without a gap with a sensitivity of 0.71, specificity of 0.81, and
predictive accuracy of 0.75. Conclusion: A target LI drop of 15 ohm at
each RFA with a 4-mm distance between adjacent ablation points may
facilitate creation of sufficient ablation lesions during PV isolation