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Electrogram voltage and pacing threshold before ablation, measured by mini-electrodes, predict parameters indicative of transmural lesions in the human atrium.

Authors
  • Lázaro, Carla1
  • Barrio-López, Teresa1
  • Castellanos, Eduardo1
  • Ortiz, Mercedes1
  • Arceluz, Martín1
  • Almendral, Jesús2
  • 1 Electrophysiology Laboratory and Arrhythmia Unit, Hospital Madrid Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Avda. Montepríncipe, 25 28660, Madrid, Boadilla del Monte, Spain. , (Spain)
  • 2 Electrophysiology Laboratory and Arrhythmia Unit, Hospital Madrid Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Avda. Montepríncipe, 25 28660, Madrid, Boadilla del Monte, Spain. [email protected] , (Spain)
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Apr 01, 2020
Volume
57
Issue
3
Pages
443–452
Identifiers
DOI: 10.1007/s10840-019-00539-6
PMID: 31049825
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

An important attenuation of the atrial signal recorded with mini-electrodes (ME) embedded in an 8-mm tip was associated with a transmural radiofrequency lesion. Our aim was to assess if parameters obtained from ME or conventional bipoles before applications predict successful atrial lesions. We prospectively included 33 consecutive patients undergoing cavotricuspid isthmus (CTI) ablation. Electrogram voltages and pacing thresholds were measured with ME and conventional bipoles before and after radiofrequency (RF) applications. The time before the loss of capture during applications was recorded. Lesions were considered successful, in accordance with preclinical data, if ME voltage decreased > 54%. Of 207 applications, 107 could be analyzed. During applications, voltages decreased more in the ME than in the conventional bipoles (66.8 ± 26.1% vs 37.5 ± 42.5%, P = 0.001). Likewise, pacing threshold increased significantly more using the ME (86.3 ± 22.9% ME, 52.6 ± 35.6% conventional, P = 0.001). ME pre-ablation voltages were significantly higher and pacing thresholds significantly lower in successful lesions (voltage 0.88 ± 0.71 vs 0.26 ± 0.18 mV, P = 0.0001; threshold 1.6 ± 1.7 vs 2.8 ± 3.0, P = 0.04). Neither of these parameters with conventional bipoles nor time to loss of capture showed differences. A ME voltage > 0.33 mV and a pacing threshold < 1.5 mA predicted a successful lesion with 0.78 and 0.6 sensitivity and 0.78 and 0.59 specificity. Certain pre-ablation parameters derived from ME such as electrogram voltage and pacing threshold differ from those obtained by a conventional configuration and can predict a successful atrial lesion.

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