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Local impedance to guide focal radiofrequency ablation: there is life in the old dog yet
  • Gavin S Chu,
  • Dhiraj Gupta
Gavin S Chu
Liverpool Heart and Chest Hospital NHS Foundation Trust
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Dhiraj Gupta
Liverpool Heart and Chest Hospital
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Abstract

Despite being first described over 30 years ago, focal radiofrequency (RF) continues to be the most widely used energy modality for catheter ablation. The fact that it has managed to hold its own against stiff competition from alternative energy sources used for pulmonary vein isolation (PVI) is down to continuous evolution based on enhancements in our understanding of its biophysical principles. In particular, the advent of contact-force (CF) based integrated indices such as Ablation Index have improved both efficacy and safety. However, a significant limitation of this approach is the absence of tissue feedback during lesion creation, which results in a blunt ‘one-size-fits-all’ approach. This limitation has been further brought into focus by the recent appreciation of the much greater importance of circuit impedance rather than delivered power as a fundamental determinant of RF lesion size.

Peer review status:ACCEPTED

05 Apr 2021Submitted to Journal of Cardiovascular Electrophysiology
08 Apr 2021Assigned to Editor
08 Apr 2021Submission Checks Completed
11 Apr 2021Editorial Decision: Accept