Novel Impedance-Guided Contact Mapping Technique for the Circular Multielectrode Pulsed-Field Ablation Catheter

Area of Science:

• Electrophysiology
• Medical Devices
• Cardiac Ablation

Background:

• Accurate electrode-tissue contact is crucial for effective pulmonary vein isolation (PVI) during atrial fibrillation (AF) treatment.
• Traditional methods for assessing contact can be indirect or rely on fluoroscopy.

Purpose of the Study:

• To evaluate the feasibility and efficacy of impedance-guided PulseSelect contact mapping (i-Pulse) for real-time visualization of electrode-tissue contact.
• To assess the utility of i-Pulse in guiding PVI procedures using a circular multielectrode PFA catheter.

Main Methods:

• i-Pulse adapted the EnSite X Contact Index for a circular multielectrode PFA catheter.
• Intracardiac echocardiography (ICE) guidance was used in conjunction with i-Pulse.
• A change in impedance (Δimpedance) > 5% was established as the criterion for adequate contact.

Main Results:

• i-Pulse enabled real-time visualization of electrode-tissue contact without fluoroscopy.
• The Δimpedance > 5% criterion effectively identified adequate contact and allowed for standardized tagging.
• The technique successfully guided PVI in three AF cases, achieving acute isolation without complications.

Conclusions:

• Impedance-guided PulseSelect contact mapping is a viable tool for real-time assessment of electrode-tissue contact during PFA procedures.
• i-Pulse, guided by ICE, facilitates safe and effective PVI for atrial fibrillation.
• This technology offers a non-fluoroscopic approach to optimize contact during catheter ablation.