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Clinical utility of local impedance monitoring during pulmonary vein isolation
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  • Masaharu Masuda,
  • Takashi Kanda,
  • Naoya Kurata,
  • Mitsutoshi Asai,
  • Osamu Iida,
  • shin Okamoto,
  • Takayuki Ishihara,
  • Kiyonori Nanto,
  • Takuya Tsujimura,
  • Yasuhiro Matsuda,
  • Yosuke Hata,
  • Hiroyuki Uematsu,
  • Toshiaki Mano
Masaharu Masuda
Kansai Rosai Hospital
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Takashi Kanda
Kansai Rosai Hospital
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Naoya Kurata
Kansai Rosai Hospital
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Mitsutoshi Asai
Kansai Rosai Hospital
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Osamu Iida
Kansai Rosai Hospital
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shin Okamoto
Kansai Rosai Hospital
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Takayuki Ishihara
Kansai Rosai Hospital
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Kiyonori Nanto
Kansai Rosai Hospital
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Takuya Tsujimura
Kansai Rosai Hospital
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Yasuhiro Matsuda
Kansai Rosai Hospital
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Yosuke Hata
Kansai Rosai Hospital
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Hiroyuki Uematsu
Kansai Rosai Hospital
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Toshiaki Mano
Kansai Rosai Hospital
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Peer review status:UNDER REVIEW

18 May 2020Submitted to Journal of Cardiovascular Electrophysiology
20 May 2020Submission Checks Completed
20 May 2020Assigned to Editor
21 May 2020Reviewer(s) Assigned
13 Jun 2020Review(s) Completed, Editorial Evaluation Pending
15 Jun 2020Editorial Decision: Revise Minor
17 Jun 20201st Revision Received
18 Jun 2020Submission Checks Completed
18 Jun 2020Assigned to Editor
18 Jun 2020Reviewer(s) Assigned
04 Jul 2020Review(s) Completed, Editorial Evaluation Pending
06 Jul 2020Editorial Decision: Revise Minor
08 Jul 20202nd Revision Received
09 Jul 2020Submission Checks Completed
09 Jul 2020Assigned to Editor
09 Jul 2020Reviewer(s) Assigned
11 Jul 2020Review(s) Completed, Editorial Evaluation Pending

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