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175/Ablation catheter motion detection during contact force and VISITAG Module-guided pulmonary vein isolation – Improving the accuracy of radiofrequency annotation

European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr175

Background: During contact force (CF) and VISITAG™ Module (Biosense Webster) guided pulmonary vein isolation (PVI), ACCURESP™ respiratory motion adjustment is recommended, although without in vivo validation.

Objective: Since accurate LAPW radiofrequency (RF) annotation is crucial to avoid oesophageal thermal injury, we compared ACCURESP™ setting (“on” versus “off”) on RF annotation at the left atrial posterior wall (LAPW).

Methods: From a twenty-five patient cohort undergoing CF PVI (continuous RF, 30 W) using general anaesthesia and VISITAG™ Module annotation-guidance (force-over-time 100% minimum 1 g, 2 mm position stability, ACCURESP™ “off”), respiratory motion detection occurred in eight, permitting retrospective comparison of ACCURESP™ settings.

Results: There were significant differences in LAPW RF data annotation according to ACCURESP™ setting (Table 1). Comparing ACCURESP™ ’on‘ versus ’off‘, respectively: total annotated sites 82 versus 98; Median RF duration per-site 13.3 s versus 10.6 s (p<0.0001); Median force time integral 177 g.s versus 130 g.s (p=0.0002); Mean inter-lesion distance (ILD) 6.0 mm versus 4.8 mm (p=0.002). Considering only annotated site 1-to-2 transitions, three occurred with 0 g CF; ACCURESP™ ’on‘ minus ’off‘ difference in RF duration was <0.6 s. However, 13 site 1-to-2 transitions during constant catheter-tissue contact (ILD range 2.1–7.0 mm) demonstrated a mean difference in annotated RF duration at site 1, of 3.7 s (range: –1.3–11.3 s). Reconstituted curves displaying catheter position data, CF, impedance and site 1-to-2 transition according to ACCURESP™ setting, demonstrated multiple markers of catheter movement coinciding with ACCURESP™ ’off’.

Conclusions: During CF and VISITAG™ Module annotation-guided PVI, ACCURESP™ respiratory adjustment results in important delays to the identification and annotation of sites of deliberate catheter motion of up to 5–7 mm at the LAPW. Therefore, previously derived ablation targets using ACCURESP™ set “on” may be importantly flawed, and on-going respiratory adjustment use is likely to represent an important impediment towards greater PVI procedural reproducibility, efficacy and safety. In contrast, RF annotation with ACCURESP™ set “off” demonstrated suitable catheter motion detection capabilities. Based on these findings, we recommend setting ACCURESP™ “off” during VISITAG™ Module and CF-guided PVI.

 

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