Peak frequency drop: a novel intraprocedural parameter predicting acute conduction gaps post-pulmonary vein isolation

Area of Science:

• Electrophysiology
• Cardiac Ablation
• Medical Device Technology

Background:

• Identifying residual gaps after pulmonary vein isolation (PVI) is critical for successful ablation.
• Evaluating electrogram changes, specifically peak frequency (PF), can help detect these gaps.

Purpose of the Study:

• To assess changes in peak frequency (PF) on electrograms after PVI.
• To determine the relationship between PF values and residual pulmonary vein (PV) gaps.

Main Methods:

• Patients with PV gaps post-PVI using a novel irrigated-tip catheter (TactiFlex) were included.
• Peak frequency (PF) was recorded pre- and post-ablation using Omnipolar technology.
• PF drop, contact force, and impedance drop were compared between points with and without PV gaps.

Main Results:

• A significant difference in PF drop was observed between points with and without PV gaps (-14 Hz vs. 61 Hz, p < 0.001).
• PF drop demonstrated high predictive value (AUC 0.878) for identifying PV gaps, with a cutoff of 10.5 Hz.
• Lower PF drop and contact force were associated with the presence of a PV gap.

Conclusions:

• Peak frequency (PF) drop during PVI is a valuable indicator for predicting residual pulmonary vein gaps.
• This parameter can enhance the efficacy of PVI by identifying incomplete lesions.