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Left heart catheterization is an invasive diagnostic procedure used to evaluate the function and structure of the left side of the heart. It is generally performed to diagnose and treat cardiovascular conditions such as valve abnormalities, coronary artery disease, and congenital heart defects.Diagnostic and therapeutic purposesLeft heart catheterization serves various diagnostic and therapeutic purposes, including:Assessing coronary artery bypass grafts.Evaluating coronary artery disease in...
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Optimization of Transesophageal Atrial Pacing to Assess Atrial Fibrillation Susceptibility in Mice
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Relationship between left atrium catheter contact force and pacing threshold.

Teresa Barrio-López1,2, Mercedes Ortiz3, Eduardo Castellanos3

  • 1Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain. terebarriol@gmail.com.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|April 29, 2017
PubMed
Summary

Pacing thresholds in the left atrium correlate with contact force, offering a potential method to assess force during procedures. A unipolar pacing threshold below 2.85 mA with normal bipolar voltage indicates good contact.

Keywords:
AblationContact forceLeft atriumPacing threshold

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Area of Science:

  • Electrophysiology
  • Cardiac Ablation
  • Atrial Fibrillation Management

Background:

  • Contact force (CF) is crucial for effective pulmonary vein isolation during atrial fibrillation ablation.
  • Direct measurement of CF can be challenging in the left atrium (LA).
  • Understanding surrogates for CF is important for optimizing ablation outcomes.

Purpose of the Study:

  • To investigate the relationship between contact force and pacing threshold in the human left atrium.
  • To determine if pacing threshold can serve as a surrogate for contact force in the LA.

Main Methods:

  • Evaluated 188 left atrial sites in 28 patients undergoing atrial fibrillation ablation.
  • Measured median contact force, electrogram voltage, impedance, and bipolar/unipolar pacing thresholds.
  • Analyzed correlations between pacing thresholds and contact force for consistent constant and intermittent capture.

Main Results:

  • Both unipolar and bipolar pacing thresholds significantly correlated with median contact force.
  • Unipolar pacing threshold showed a stronger correlation with contact force (Spearman Rho -0.62).
  • A unipolar pacing threshold <2.85 mA combined with normal bipolar voltage predicted good contact force (>10 g) with 80% specificity and 74% sensitivity.

Conclusions:

  • Pacing thresholds are a valid correlate of contact force in the non-ablated human left atrium.
  • Pacing threshold, particularly unipolar, may serve as a useful surrogate for assessing contact force.
  • The combination of normal bipolar voltage and a low unipolar pacing threshold offers a reliable indicator of adequate contact force.