Impedance drop predicts acute electrical reconnection of the pulmonary vein-left atrium after pulmonary vein isolation u
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Impedance drop predicts acute electrical reconnection of the pulmonary vein-left atrium after pulmonary vein isolation using short-duration high-power exposure Kyoichiro Yazaki 1 & Koichiro Ejima 1,2 Morio Shoda 1,2 & Nobuhisa Hagiwara 1
&
Miwa Kanai 1 & Shohei Kataoka 1 & Satoshi Higuchi 1 & Daigo Yagishita 1 &
Received: 5 July 2019 / Accepted: 12 December 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To determine the efficacy and identify the relevant factors for durable lesion creation in pulmonary vein isolation (PVI) using a high-power short-duration (HPSD) strategy. Methods Thirty-two consecutive patients who underwent PVI using HPSD (50 W) (HP group: HP-G) were compared with 32 controls using normal power (25–40 W) (conventional group: C-G). The segments were divided into 12 segments per group; thus, there were 768 segments for analysis. Radiofrequency (RF) ablation (RFA) was mainly performed under guidance with a unipolar electrogram at the distal tip of the ablation catheter in both groups. The high-power strategy reduced radiofrequency energy (P < 0.0001), RFA time (P < 0.0001), acute pulmonary vein reconnection (PVR) segments (P = 0.02), and several threedimensional-mapping-related indices except for minimum impedance drop (Imp-min). Results There was a significant difference only in Imp-min between the subjects with acute PVR and those without in the HP-G (P = 0.002). Multivariate analysis revealed Imp-min to be the only independent predictor of the absence of PVR after adjusting for maximum inter-lesion distance and minimum ablation index (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.07–1.39, P = 0.001). In the region-specific analysis, this was attenuated in posterior segments, where the HP strategy independently predicted the absence of PVR (OR 2.80 [95% CI 1.32–6.30], P = 0.007). Conclusion The HPSD strategy reduced RF time, RF energy, and three-dimensional mapping-related indices but also improved the acute outcome. The HP strategy may be a sophisticated strategy under guidance with the impedance drop rather than the ablation index. Keywords Atrial fibrillation . Catheter ablation . Pulmonary vein isolation . High-power short-duration strategy . Impedance drop
1 Introduction Pulmonary vein isolation (PVI) is an established therapy for the management of drug-refractory paroxysmal atrial fibrillation (AF) [1, 2]. Unresolved problems include a significant Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10840-019-00691-z) contains supplementary material, which is available to authorized users. * Koichiro Ejima [email protected] 1
Department of Cardiology, Tokyo Women’s Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo 162-8666, Japan
2
Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
number of recurrences of atrial tachyarrhythmia (ATA), which are strongly associated with pulmonary vein reconnection (PVR)
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