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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.

Authors
  • Yazaki, Kyoichiro1
  • Ejima, Koichiro2, 3
  • Kanai, Miwa1
  • Kataoka, Shohei1
  • Higuchi, Satoshi1
  • Yagishita, Daigo1
  • Shoda, Morio1, 4
  • Hagiwara, Nobuhisa1
  • 1 Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan. , (Japan)
  • 2 Department of Cardiology, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan. [email protected] , (Japan)
  • 3 Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. [email protected] , (Japan)
  • 4 Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan. , (Japan)
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Dec 01, 2020
Volume
59
Issue
3
Pages
575–584
Identifiers
DOI: 10.1007/s10840-019-00691-z
PMID: 31902084
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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 three-dimensional-mapping-related indices except for minimum impedance drop (Imp-min). 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). 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.

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