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Contact force and impedance decrease during ablation depends on catheter location and orientation: insights from

Sven Knecht1, Tobias Reichlin, Nikola Pavlovic

  • 1Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland, sven.knecht@usb.ch.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|May 1, 2015
PubMed
Summary

Contact force (CF) sensing in radiofrequency (RF) ablation is crucial for lesion control. This study found that catheter location and orientation significantly impact the association between CF and impedance decrease, influencing ablation effectiveness.

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Area of Science:

  • Electrophysiology
  • Cardiovascular Interventions
  • Medical Device Technology

Background:

  • Contact force (CF) sensing during radiofrequency (RF) ablation is vital for controlling lesion size and ensuring effective treatment.
  • Understanding the interplay between CF, catheter positioning, and ablation outcomes is essential for optimizing procedural success.

Purpose of the Study:

  • To investigate the influence of catheter tip location and orientation on the relationship between contact force and impedance decrease during RF ablation.
  • To analyze how anatomical location (right vs. left pulmonary veins) and catheter angle affect ablation efficacy.

Main Methods:

  • Retrospective analysis of 791 RF applications from 32 patients undergoing catheter ablation for paroxysmal atrial fibrillation.
  • Utilized a force-sensing catheter and 3D mapping system to record CF, catheter location, and orientation.
  • Assessed absolute impedance decrease within the first 20 seconds as a surrogate for lesion effectiveness.

Main Results:

  • Higher CF was observed around the right pulmonary veins compared to the left (12.5 vs. 11.4 g).
  • A lower median impedance decrease was noted around the right pulmonary veins (9.3 vs. 10.2 Ω).
  • Parallel or oblique catheter orientations (30°-145°) yielded higher CF (13.2 vs. 8.0 g) and impedance decrease (11 vs. 7 Ω) compared to perpendicular orientations (0-30°).
  • Multivariable analysis confirmed that CF, baseline impedance, catheter orientation, and location independently predicted impedance decrease (p < 0.05).

Conclusions:

  • The effectiveness of RF ablation lesions, indicated by impedance decrease, is influenced by achieved contact force.
  • Catheter orientation and location are critical independent factors affecting RF ablation lesion efficacy.
  • Optimizing catheter positioning and orientation alongside contact force is necessary for predictable ablation outcomes.