Mechanistic insights into heterogeneous radiofrequency ablation effects at the left atrial posterior wall during pulmonary vein isolation

David R. Tomlinson
2019 · doi:10.1101/19008706
preprint OA: closed CC-BY-NC-4.0
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⚙ AI-generated summary by claude@2026-07, 2026-07-15 ⓘ

This study investigated radiofrequency ablation heterogeneity at the left atrial posterior wall during pulmonary vein isolation, finding greater ablation effects on the left side potentially due to increased contact surface area and in-phase catheter-tissue motion.

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Abstract

Background Independent investigations demonstrate greater radiofrequency (RF) ablation effects at left- sided left atrial posterior wall (LAPW) sites. Objective To investigate mechanisms underlying RF ablation heterogeneity during contact-force (CF) and VISITAG™ Module (Biosense Webster)-guided pulmonary vein isolation (PVI). Methods Consecutive patients undergoing PVI during atrial overdrive pacing comprised 2 cohorts: intermittent positive pressure ventilation (IPPV, 14-16/min, 6-8ml/kg); high frequency jet ventilation (HFJV, 150/min, Monsoon III, Acutronic). Temperature-controlled (17ml/min, 48°C) RF data was retrospectively assessed at first-annotated (target 15s) LAPW sites: 30W during IPPV; 20W at left-sided sites during HFJV. Results Twenty-five and 15 patients underwent PVI during IPPV and HFJV, respectively. During IPPV, left versus right-sided median impedance drop (ImpD) was 13.6Ω versus 9.9Ω (p<0.0001) respectively and mean time to pure R unipolar electrogram (UE) morphology change 4.9s versus 6.7s (p=0.007) respectively. During HFJV, ImpD was greater at left-sided sites (9.7Ω versus 7.4Ω, p=0.21) and time to pure R UE significantly shorter: 4.3s versus 6.1s (p=0.02). Minimum case impedance subtracted from pre-RF baseline impedance (BI) generated site-specific ΔBI. Left-sided sites demonstrated significantly greater ΔBI, correlating strongly with Ln(ImpD) – IPPV r=0.84 (0.65 – 0.93), HFJV r=0.77 (0.35 – 0.93). At right-sided sites, ΔBI and Ln(ImpD) were without correlation during IPPV, but correlation was modest during HFJV (r=0.54, -0.007 – 0.84). Conclusions ΔBI may usefully indicate catheter-tissue contact surface area (SA). Consequently, greater left-sided LAPW RF effect may result from greater contact SA and in-phase catheter-tissue motion; HFJV may reduce right-sided out-of-phase catheter-tissue motion. Modifying RF delivery based on ΔBI may improve PVI safety and efficacy.

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License: CC-BY-NC-4.0