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Standardized parallel pace-capture testing as a functional endpoint for lesion validation.

Shin Nakamura1, Masateru Takigawa2, Ryosuke Kato3

  • 1Department of Cardiovascular Medicine, Institute of Science Tokyo Hospital, Tokyo, Japan; Tokyo Metropolitan Tama-Nambu Chiiki Hospital, Tokyo, Japan.

Heart Rhythm
|May 26, 2026
PubMed
Summary

Catheter orientation significantly impacts electrogram readings in non-ablated heart tissue. Pacing threshold testing after radiofrequency lesions may offer a more reliable measure of lesion integrity than electrograms alone.

Keywords:
Bipolar electrogramCatheter ablationCatheter–tissue angleHigh-density mappingOmnipolar mappingPacing thresholdPeak frequencySwine

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Area of Science:

  • Electrophysiology
  • Cardiac Ablation
  • Medical Device Technology

Background:

  • Electrogram (EG) metrics for assessing radiofrequency (RF) lesion quality are highly sensitive to catheter orientation and design.
  • The functional reliability of pacing threshold as a marker for lesion integrity, independent of EG reduction, is not well established.

Purpose of the Study:

  • To investigate the impact of catheter-tissue angle and catheter type on in vivo electrogram voltage, peak frequency (PF), and pacing threshold.
  • To evaluate the utility of pacing threshold as a functional marker for RF lesion integrity.

Main Methods:

  • Utilized a contact force-sensing ablation catheter in swine for right atrial mapping.
  • Measured electrograms and pacing thresholds at non-ablated and RF lesioned sites under varying catheter contact angles (parallel vs. non-parallel).
  • Compared an HD Grid mapping catheter with the ablation catheter at co-localized sites.

Main Results:

  • In non-ablated myocardium, parallel catheter contact significantly increased voltage and PF, and decreased pacing threshold compared to non-parallel contact (P<0.0001).
  • Within RF lesions, voltage and PF were low and angle-independent (P≥0.53).
  • Pacing threshold remained lower with parallel contact in lesions (median 2.2 vs 3.4 mA, P=0.006), particularly in insufficient lesions. HD Grid catheter showed higher omnipolar voltage and PF than the ablation catheter.

Conclusions:

  • Catheter orientation significantly influences electrogram measurements in non-ablated cardiac tissue.
  • Standardized parallel pace-capture testing may offer functional insights into residual excitability in RF lesions.
  • Electrogram-based cutoffs for lesion assessment necessitate catheter- and orientation-specific interpretation.