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Identification of deliberate catheter motion at the left atrial posterior wall during pulmonary vein isolation: Validity of respiratory motion adjustment
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  • David Tomlinson,
  • Katie Biscombe,
  • John True,
  • Joanne Hosking,
  • Adam Streeter
David Tomlinson
Plymouth Hospitals NHS Trust
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Katie Biscombe
Plymouth University Peninsula Schools of Medicine and Dentistry
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John True
Plymouth University Peninsula Schools of Medicine and Dentistry
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Joanne Hosking
Plymouth University Peninsula Schools of Medicine and Dentistry
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Adam Streeter
Plymouth University Peninsula Schools of Medicine and Dentistry
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Abstract

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, 30W) using general anaesthesia and automated RF annotation-guidance (VISITAG™: force-over-time 100% minimum 1g; 2mm position stability; ACCURESP™ RMA “off”) in 25 patients, we retrospectively examined RMA settings “on” versus “off” at the left atrial posterior wall (LAPW). Results Respiratory motion detection occurred in 8, permitting offline retrospective comparison of RMA settings. Significant differences in LAPW RF auto-annotation occurred according to RMA setting, with curves displaying catheter position, CF and impedance data indicating “best-fit” for catheter motion detection using RMA “off”. Comparing RMA “on” versus “off”, respectively: Total annotated sites 82 versus 98; median RF duration per-site 13.3s versus 10.6s (p<0.0001); median force time integral 177g.s versus 130g.s (p=0.0002); mean inter-tag distance (ITD) 6.0mm versus 4.8mm (p=0.002). Considering LAPW annotated site 1-to-2 transitions resulting from deliberate catheter movement, 3 concurrent with inadvertent 0g CF demonstrated <0.6s difference in RF duration. However, 13 deliberate catheter movements during constant tissue contact (ITD range 2.1 – 7.0mm) demonstrated (mean) site-1 RF duration difference 3.7s (range: -1.3 to 11.3s): considering multiple measures of catheter position instability, the appropriate indication of deliberate catheter motion occurred with RMA “off” in all. Conclusions ACCURESP™ respiratory motion adjustment importantly delayed the identification of deliberate and clinically relevant catheter motion during LAPW RF delivery, rendering auto-annotated RF display invalid. Operators seeking greater accuracy during auto-annotated RF delivery should avoid RMA use.

Peer review status:ACCEPTED

25 Nov 2020Submitted to Journal of Cardiovascular Electrophysiology
26 Nov 2020Submission Checks Completed
26 Nov 2020Assigned to Editor
29 Nov 2020Reviewer(s) Assigned
13 Dec 2020Review(s) Completed, Editorial Evaluation Pending
14 Dec 2020Editorial Decision: Revise Minor
20 Jan 20211st Revision Received
28 Jan 2021Submission Checks Completed
28 Jan 2021Assigned to Editor
28 Jan 2021Reviewer(s) Assigned
06 Feb 2021Review(s) Completed, Editorial Evaluation Pending
08 Feb 2021Editorial Decision: Accept