Anterior dispersive patch electrode position during pulmonary vein isolation using radiofrequency -- a pilot feasibility study

Anterior dispersive patch electrode position during pulmonary vein isolation using radiofrequency -- a pilot feasibility study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 1 April 2025 V1 Latest version Share on Anterior dispersive patch electrode position during pulmonary vein isolation using radiofrequency -- a pilot feasibility study Authors : Łukasz Zarębski 0000-0003-2524-7950 [email protected] , Mateusz A. Iwański , Natalia Burda , Agata Surowiec , Aleksandra Cieplińska , Patrycja Świerczek-Augustyn , Marian Futyma , and Piotr Futyma 0000-0003-0219-7612 Authors Info & Affiliations https://doi.org/10.22541/au.174347478.88332751/v1 200 views 100 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction: Ablation for atrial fibrillation (AF) carries a significant risk of esophageal injury, including esophageal wall ulceration, peri-esophageal injury or life-threatening atrio-esophageal fistula (AEF). Current methods of esophageal protection are invasive, expensive and their cost-effectiveness is debatable. Standard placement of dispersive patch electrode (DPE) at patient’s back may expose the esophagus to thermal injury from radiofrequency (RF) currents. Repositioning the DPE to the anterior chest could theoretically protect the esophagus from thermal injury, however, such an approach has not yet been investigated. Methods: We retrospectively analyzed three cohorts of consecutive patients undergoing patients RFCA-based pulmonary vein isolation (PVI). The first cohort underwent PVI performed using a multi-electrode PVAC catheter with the DPE placed either anteriorly or posteriorly. The second cohort underwent point-by-point RFCA, including mapping of pulmonary vein ostia and impedance measurements, with DPE placed anteriorly and posteriorly during impedance measurements. The third cohort underwent high-power short-duration (HPSD) PVI with an anterior DPE placement. Impedance values, procedural characteristics, and follow-up outcomes were compared across the cohorts. Results: The first cohort included 62 patients (25 females, age 60 ± 12 years). Forty of them had DPE placed posteriorly and 22 anteriorly. There were no major procedural complications. AF recurrence rates at one-year follow-up did not differ significantly between the anterior and posterior DPE groups (23% vs 43%, log-rank p = 0.074). The second cohort consisted of 12 patients (2 females, age 61 ± 10 years) undergoing point-by-point PVI. Significant impedance differences were observed between posterior and anterior DPE placements for both Erbe DPE (131±14 Ω vs 147±16 Ω, p<0.0001) and Covidien DPE (117±14 Ω vs 125±17 Ω, p=0.018). No complications were reported during a 7±5 months of follow-up. The third cohort included 83 patients (51 males, mean age 62±12 years) undergoing HPSD PVI. All pulmonary veins were successfully isolated. No AEF or esophageal injuries were reported during a mean follow-up of 7±5 months. Conclusions: Anterior position of the DPE during RFCA-based PVI is safe, feasible, non-traumatic and is not associated with any additional cost. Its potential to prevent esophageal complications should be further investigated in prospective studies. Anterior dispersive patch electrode position during pulmonary vein isolation using radiofrequency – a pilot feasibility study Łukasz Zarębski 1,2,3 , Mateusz A. Iwański 1 , Natalia Burda 1 , Agata Surowiec 1 , Aleksandra Cieplińska 1 , Patrycja Świerczek-Augustyn 1 , Marian Futyma 1 , Piotr Futyma 1,2 1. St. Joseph’s Heart Rhythm Center, Rzeszów, Poland 2. Medical College of University of Rzeszów, Rzeszów, Poland 3. Department of Cardiology, Hospital of the Ministry of Interior and Administration, Rzeszów, Poland Corresponding author: Łukasz Zarębski, MD St. Joseph’s Heart Rhythm Center Anny Jagiellonki 17, 35-623, Rzeszów, Poland, e-mail: [email protected] mobile: +48 515 520 275 Funding: none Disclosures: Dr. Futyma reports patent applications related with bipolar and high-voltage ablation and that he has equity in CorSystem. Word count: 4077 Introduction: Ablation for atrial fibrillation (AF) carries a significant risk of esophageal injury, including esophageal wall ulceration, peri-esophageal injury or life-threatening atrio-esophageal fistula (AEF). Current methods of esophageal protection are invasive, expensive and their cost-effectiveness is debatable. Standard placement of dispersive patch electrode (DPE) at patient’s back may expose the esophagus to thermal injury from radiofrequency (RF) currents. Repositioning the DPE to the anterior chest could theoretically protect the esophagus from thermal injury, however, such an approach has not yet been investigated. Methods: We retrospectively analyzed three cohorts of consecutive patients undergoing patients RFCA-based pulmonary vein isolation (PVI). The first cohort underwent PVI performed using a multi-electrode PVAC catheter with the DPE placed either anteriorly or posteriorly. The second cohort underwent point-by-point RFCA, including mapping of pulmonary vein ostia and impedance measurements, with DPE placed anteriorly and posteriorly during impedance measurements. The third cohort underwent high-power short-duration (HPSD) PVI with an anterior DPE placement. Impedance values, procedural characteristics, and follow-up outcomes were compared across the cohorts. Results: The first cohort included 62 patients (25 females, age 60 ± 12 years). Forty of them had DPE placed posteriorly and 22 anteriorly. There were no major procedural complications. AF recurrence rates at one-year follow-up did not differ significantly between the anterior and posterior DPE groups (23% vs 43%, log-rank p = 0.074). The second cohort consisted of 12 patients (2 females, age 61 ± 10 years) undergoing point-by-point PVI. Significant impedance differences were observed between posterior and anterior DPE placements for both Erbe DPE (131±14 Ω vs 147±16 Ω, p<0.0001) and Covidien DPE (117±14 Ω vs 125±17 Ω, p=0.018). No complications were reported during a 7±5 months of follow-up. The third cohort included 83 patients (51 males, mean age 62±12 years) undergoing HPSD PVI. All pulmonary veins were successfully isolated. No AEF or esophageal injuries were reported during a mean follow-up of 7±5 months. Conclusions: Anterior position of the DPE during RFCA-based PVI is safe, feasible, non-traumatic and is not associated with any additional cost. Its potential to prevent esophageal complications should be further investigated in prospective studies. Keywords: Dispersive patch electrode, pulmonary vein isolation, atrial fibrillation, atrioesopheagal fistula Graphical abstract Introduction Catheter ablation is an effective treatment strategy for symptomatic atrial fibrillation (AF) (1,2) and a complete electrical isolation of all the pulmonary veins (PVs) is considered as the best AF ablation endpoint (3,4). Achieving this goal frequently requires an extensive left atrial lesion set and this strategy may not be free of risk. While local complications associated with vascular access are most common (5,6), some other less frequent adverse events such as AEF can be possibly devastating. Pulmonary vein isolation (PVI) can be associated with the risk of AEF, which is a rare but fatal complication in case of its occurrence (7,8). Due to the proximity of the esophagus to the posterior left atrial wall, the main cause of fistula formation is a thermal injury caused by the PVI lesions. Numerous methods aiming to prevent thermal esophageal injuries during AF ablations were described however, none of them was proven to be definitely effective for AEF prevention (9). Ideally, an effective, inexpensive, noninvasive, and broadly available technique for reducing esophageal injury during AF ablation for the prevention of AEF would be welcomed (8). Recently, more attention was brought to the dispersive patch electrode (DPE) position during radiofrequency ablation for optimization of energy delivery (10–14). The DPE is traditionally positioned on a patient’s back (14). However, such an approach, can theoretically increase the likelihood of thermal injury to the structures on the path of alternating radiofrequency current between ablation catheter tip and DPE, including esophagus (15,16). Alternatively, DPE repositioning to the front of the chest reverses the directivity of radiofrequency current and this can prevent radiofrequency current overshooting or its accumulation at the path between DPE and ablation catheter tip (17). Literature data on such DPE frontal repositioning is extremely scarce. The aim of this study was to determine the feasibility and outcomes of the anterior chest DPE position during radiofrequency-based PVI. Materials and methods The study complied with the Declaration of Helsinki and was approved by the Institutional Review Board. All procedures were performed using the EP Tracer electrophysiology system (Cardiotek, Maastricht, The Netherlands) for signals acquisition. Radiofrequency energy was delivered with the EP Shuttle generator (Stockert GmbH, Freiburg, Germany). Mapping was guided by electroanatomic mapping using the CARTO™ (Biosense Webster, Diamond Bar, CA, USA) or EP Navigator (Phillips, Best, the Netherlands) system. In the first feasibility phase of the study consecutive patients undergoing PVI using multielectrode PVAC catheter (Medtronic Inc., Minneapolis, MN, USA) were randomly assigned to either anterior or posterior dispersive patch position (Figure 1) . After achieving an activated clotting time of >350 seconds, a coronary sinus (CS) catheter was inserted through double venous access. 3-4 phased RF applications per pulmonary vein were applied, and the effectiveness of isolation was confirmed with abolition of PV signals and pacing manoeuvrers from the PVs. In the second phase of the study, consecutive patients undergoing point-by-point PVI had systematic measurements of impedance obtained in 2 aspects (anterior and posterior) of all four PVs (RSPV, RIPV, LSPV, LIPV) and at anterior and posterior DPE positions. Two types of patches were used: Erbe Reusable Silicon Neutral Electrode (Erbe Electromedizin GmbH, Tubingen, Germany) or Covidien REM Polyhesive (Valleylab, Boulder, CO, USA). In the third phase consecutive patients who underwent high-power short-duration ( HPSD) PVI with a flexible-tip catheter (FlexAbiltity, Abbott, St. Paul, MN, USA) and anterior position of dispersive electrodes (DE) were included in the study ( Figure 2) . The HPSD protocol consisted of 70W RF applications lasting 4-15s. RFCA applications were continued until R-positive unipolar signal modification and/or until a ≥10% impedance drop from baseline was achieved . All patients were monitored for recurrence of AF and possible post-operative complications. AF/AT/AFL recurrence was defined as an AF/AT/AFL episode lasting >30 seconds on any ECG recording. Statistical analysis Continuous variables were presented as mean±standard deviation or median (interquartile range) based on the distribution. Categorical variables were expressed as percentages. Comparative analyses were conducted using t-tests for continuous variables and chi-square or Fisher’s exact tests for categorical variables where appropriate. Kaplan-Meier curves and log-rank test were used to determine any differences in event rates during follow-up. A p-value <0.05 was considered to indicate statistical significance. Results In the first phase of the study 62 patients (25 females, age 60 ± 12 years) underwent PVI using the PVAC. Of these, 40 patients were included in the posterior placement of DPE (Posterior-DPE) and 22 in the anterior placement of DPE (Anterior-DPE) groups. Baseline demographic profiles, clinical characteristics, and procedural data for all included patients are summarized in Table 1 . A comparison of impedance values between the anterior and posterior DPE groups is presented in Figure 3 . No major complications occurred during the procedures. There was no significant difference in AF recurrence rates between the anterior and posterior DPE groups during the one-year follow-up (23% vs 43%, log rank p = 0.074). Kaplan-Meier curve for AF free survival in posterior and anterior DPE group is presented in Figure 4 . No AEF or evidence of esophageal injury were observed in either group. In the second phase of the study, further 12 consecutive patients (2 females; age 61±10 years) underwent point-by-point PVI. A total of 186 impedance measurements were taken at the ostia of all four PVs in each patient. The results for the Erbe and the Covidien DPE groups are shown in the Table 2 . Among patients using the Erbe DPE (n=7), significant difference in impedance was found depending on the DPE placement (posterior vs anterior, 131±14 Ω vs 147±16 Ω, p<0.0001). Similarly, in the Covidien DPE group (n=5), significant impedance differences between impedance values were observed between posterior and anterior DPE positions (Posterior-DPE vs Anterior-DPE; 117±14 Ω vs 125±17 Ω, p=0.018). Additionally, statistically significant differences in mean impedances were also found between the two types of DPE. The global impedance for Erbe was 139±17 Ω compared to 121±16 Ω for Covidien (p<0.0001). This trend was also observed when comparing impedances for the DPE placements: the Erbe Posterior-DPE impedance was 131±14 Ω, while Covidien Posterior-DPE was 117±14 Ω (p<0.0001); similarly, the Erbe Anterior-DPE impedance was 147±16 Ω compared to 125±17 Ω for the Covidien Anterior-DPE (p<0.0001). After impedance measurements, all patients underwent effective PVI. The mean procedural time was 108±30 minutes, with an average of 60±22 RF applications, lasting 874±313 seconds. The maximum power used was 50W, with the temperature up to 41±6°C. Mean fluoroscopy time was 15.5±0.3 minutes. No complications occurred. During the 7±5 month follow-up, no symptoms related to oesophageal injury were reported. Ten patients (83%) remained free from AF during clinical follow-up. In the third phase of the study, 83 consecutive patients (51 males, age 62±12 years) who underwent HPSD PVI using a flexible-tip catheter and anterior DPA placement, either under general anesthesia (GA) (n=40) or conscious sedation (CS) (n=43), were included. Baseline demographic and procedural for these patients are detailed in Table 3 . During HPSD PVI, all PVs were successfully isolated. Audible steam pops occurred in 0.2% of RF applications, all in the CS group, but without any clinical consequences. No steam pops were observed in the GA group. One major complication in the CS group was a transient ischemic attack (TIA) 5-hours after the PVI, but without sequelae. In the GA group no complications were observed. During a mean follow-up of 7±5 months, there were no cases of AEF or clinically-evident esophageal injury in any of groups. The AF-recurrence rate did not differ significantly between groups undergoing PVI under GA and under CS (23% vs 28%, p=0.89) ( Figure 5) . Discussion In the recent years numerous methods to prevent thermal injuries of esophageous during atrial fibrillation ablation procedures were introduced (9). The use of proton pump inhibitors, oesophageal temperature monitoring, oesophageal visualization during ablation, esophageal protection devices, and avoidance of energy supply near the esophagus are mainly empirical. Although these methods are intended to reduce the occurrence of this dramatic complication, none of them were proven to definitely avoid AEF (18–20). Most often, AEF appears within two to four weeks after surgery. While the incidence of AEF appears rare and ranges from 0.015% to 0.04%, the subsequent mortality rate is close to 100% (21). Only early diagnosis and urgent surgical repair can improve the survival of AEF (22,23). Contrary to in-silico simulations by Irastorza et al., we determined that 7 patients with the Erbe dispersion patch showed a significant difference between impedance values according to DPE position (Erbe Posterior-DPE vs Anterior-DPE, 131±14 Ω vs 147±16 Ω, p<0.0001) and 5 patients with Covidien dispersion patch had also a significant difference between impedance values according to DPE position (Covidien Posterior-DPE vs Anterior-DPE, 117±14 Ω vs 125±17 Ω, p=0.018). We’ve found statistically significant differences between the mean impedances (Erbe global vs Covidien global, 139±17 Ω vs 121±16 Ω; Erbe Posterior-DPE vs Covidien Posterior-DPE, 131±14 Ω vs 117±14 Ω; and Erbe Anterior-DPE vs Covidien Anterior-DPE, 147±16 Ω vs 125±17 Ω). Irastorza et al. proposed an in-silico model of RFCA in the left posterior atrium and right anterior ventricle using anatomical measurements obtained from CT scans of the patient’s chest. Various parameters were tested in relation to the location of the anterior and posterior DPE. It is important to note that the radiofrequency current flow might have been misrepresented. The researchers focused mainly on the myocardial scar and did not take into account some other factors. Important phenomena such as the heat sink effect, the resistivity of extracardiac structures (e.g., the aortic wall and esophagus), and the cumulation of thermal energy after consecutive RF applications, can still have some impact on radiofrequency flow in the clinical setting (24). A more complex in-silico model was presented by Anees et al., using more precise approach based on patient imaging data (25) . Their findings indicated that anterior positioning of the dispersive patch during pulmonary vein isolation (PVI) may help reduce power dissipation in the esophageal tissue, particularly when compared to the commonly used posterior placement of the DPE. Furthermore, the use of an anterior patch during ablation proved to be more effective for targeting the posterior left atrium than a posterior patch placement. Another important aspect come from significant differences between radiofrequency generator models and DPE types. Depending on each manufacturer’s recommendation, the DPE is usually located in different places on the human body. Additionally, there are also differences in DPE geometry and materials. Barkagan et al. demonstrated that RFCA with irrigated catheters in a power-controlled mode can significantly impact lesion dimensions due to baseline impedance variations. Lower impedance (90–130 Ω) increases current output, leading to increased tissue heating and larger lesion dimensions, which can heighten the risk of AEF (11). As observed in our study, repositioning the DPE from the patient’s back to the chest significantly increased the overall impedance values during RFCA. This adjustment may protect against overheating of the tissue and theoretically reduce the risk of AEF. In our study none of patients developed procedure-related severe complications. However, future prospective studies should be planned to validate the safety and effectiveness of such possible PVI optimization. Larger-scale studies are necessary to confirm these preliminary trends. General anesthesia may also have an impact on the safety of PVI. It has been reported that GA may improve electrode stability, which can potentially reduce the risk of complications, such as steam pops or atrial wall perforation (26). In our study, no complications occurred in the GA group, while in the CS group, there were several steam pops and one case of TIA. GA allows for better control of the patient’s respiratory movements and eliminates the risk of involuntary movements of the chest that can affect the precision of high-power applications (27). Additionally, the use of low tidal volume ventilation during GA helps minimize variations in lung impedance, which are typically observed between inspiration and expiration in spontaneously breathing patients. By reducing these fluctuations, low tidal volume ventilation promotes more consistent impedance values during the procedure. Despite the potential benefits of GA in reducing acute complications such as steam pops and TIA, our study did not find statistically significant differences in arrhythmia recurrence rates between patients treated under GA and those treated without it (23% vs 28%, p=0.89). Further research is needed to fully understand the long-term outcomes associated with the use of GA in PVI. Limitations This study has several limitations. First, no direct esophageal temperature measurements were performed. Future studies should include continuous esophageal temperature monitoring during ablation, as well as post-procedural esophagoscopy to detect esophageal ulceration. Second, this was a retrospective study with heterogeneous patient groups undergoing different ablation strategies, including multielectrode PVAC-based ablation, standard point-by-point RF ablation, and HPSD ablation. These differences may have influenced procedural outcomes. Third, the sample size of the Phase 2 cohort, which focused on impedance measurements, was relatively small (n=12). While statistically significant impedance differences were observed between anterior and posterior DPE placements, a larger sample size is necessary to validate these findings. Fourth, although no cases of AEF were observed, the study might not have been sufficiently powered to detect this rare complication. Long-term follow-up with a larger cohort would be required to determine whether anterior DPE positioning provides significant esophageal protection. Conclusions In the real-world clinical setting, the position of the DPE has impact on the baseline impedance. Impedance values vary between different DPE placements, with the anterior position being associated with higher output impedance during PVI, and this can act as additional oesophageal protection during surgery. The anterior DPE placement during high-power ablation using RFCA-based systems is safe, feasible, effective, non-traumatic, and is not associated with any additional costs. Properly designed prospective studies are warranted to determine the exact role of anterior DPE positioning in the prevention of AEF after RFCA. Acknowledgments The authors would like to express their gratitude to Professor Piotr Kułakowski for his guidance, expert advice, and continuous support throughout the study and ablation projects at St. Joseph’s Heart Rhythm Center, Rzeszów, Poland. References: 1. Lip GYH, Tse HF, Lane DA. Atrial fibrillation. Lancet. 2012 Feb 18;379(9816):648–61. 2. Andrade JG, Wells GA, Deyell MW, Bennett M, Essebag V, Champagne J, et al. Cryoablation or Drug Therapy for Initial Treatment of Atrial Fibrillation. New England Journal of Medicine. 2021 Jan 27;384(4):305–15. 3. Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2017 Oct;14(10):e275–444. 4. Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nat Rev Cardiol. 2021 Mar;18(3):210–25. 5. 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Kuno S, Nakano Y, Suzuki Y, Ando H, Suzuki W, Takahashi H, et al. Impact of general anesthesia on ablation catheter stability during pulmonary vein isolation based on a novel measurement approach. Sci Rep. 2023 Oct 11;13(1):17204. 27. Wang K, Jin C, Chen H, Yang G, Liu H, Wang Z, et al. General anesthesia enhances lesion quality and ablation efficiency of circumferential pulmonary vein isolation. J Arrhythm. 2024 Feb;40(1):76–82. Table 1. Baseline demographic, clinical and procedural characteristic of patients. Control group – patients with posterior placement of dispersive patch electrode. Treatment group – patients with anterior placement of dispersive patch electrode. Control group (n = 40) Treatment group (n = 22) P -value Female 14 (35%) 11 (50%) NS Age (years) 60±13 57±10 NS BMI (kg/m 2 ) 27.3±4.2 27.9±4.7 NS LVEF (%) 59±6 62±4 NS LA (mm) 40±4 42±5 NS Hypertension 23 (58%) 12 (55%) NS Diabetes 2 (5%) 1 (5%) NS Hypercholesterolemia 18 (45%) 7 (32%) NS Ischemic disease 5 (13%) 1 (5%) NS Prior stroke 1 (3%) 0 (0%) NS Prior MI 2 (5%) 2 (9%) NS Prior PCI 2 (5%) 0 (0%) NS Chronic heart failure 3 (8%) 1 (5%) NS Implanted pacemaker 1 (3%) 0 (0%) NS CHA 2 DS 2 -VASc Score 1.9±1.1 1.3±1.1 NS Procedure duration (minutes) 136±35 80±16 <0.0001 Number of RF applications 24±8 19±4 NS Time of RF applications (seconds) 1258±431 998±192 0.01 Abbreviations: BMI=Body Mass Index; LA=Left Atrium; LVEF= Left Ventricle Ejection Fraction; MI=Myocardial Infarction; PCI=Percutaneous Coronary Intervention; RF=Radiofrequency Table 2. Mean impedances for Covidien and Erbe dispersive patch electrodes RSPV - anterior aspect 134±13 148±14 115±7 124±11 0.02 0.01 RSPV – posterior aspect 129±13 143±14 114±9 123±13 0.08 0.049 RIPV - anterior aspect 140±20 155±20 126±9 139±17 0.24 0.22 RIPV - posterior aspect 131±15 148±19 123±19 134±19 0.49 0.29 LSPV -anterior aspect 128±11 147±14 113±13 122±17 0.09 0.048 LSPV - posterior aspect 131±11 149±13 121±14 124±14 0.24 0.01 LIPV - anterior aspect 130±10 145±13 109±15 117±17 0.04 0.02 LIPV - posterior aspect 127±10 144±13 109±9 117±12 0.02 0.01 Abbreviations: DPE=Dispersive Patch Electrode; LIPV=Left Inferior Pulmonary Vein; LSPV=Left Superior Pulmonary Vein; RIPV=Right Inferior Pulmonary Vein; RSPV=Right Superior Pulmonary Vein Table 3. Baseline demographic, clinical and procedural characteristics of patients undergoing high-power short-duration pulmonary vein isolation under conscious sedation and general anaesthesia. Female 18 (42%) 14 (35%) NS Age (years) 61±14 64±11 NS BMI (kg/m 2 ) 27.1±3.8 27.8±3.2 NS LVEF (%) 59±7 60±7 NS LA (mm) 41±5 42±6 NS Hypertension 25 (58%) 29 (73%) NS Diabetes 2 (5%) 6 (15%) NS Hypercholesterolemia 22 (51%) 24 (60%) NS Ischemic disease 4 (9%) 10 (25%) NS Prior stroke 5 (12%) 5 (13%) NS Prior MI 1 (2%) 0 (0%) NS Prior PCI 1 (2%) 2 (5%) NS Chronic heart failure 7 (16%) 4 (10%) NS Implanted pacemaker 3 (7%) 1 (3%) NS CHA 2 DS 2 -VASc Score 2.1±1.6 2.4±1.8 NS Procedure duration (minutes) 61±7 67±12 NS Number of RF applications 61±14 65±24 NS Time of RF applications (seconds) 687±201 683±287 NS Abbreviations: BMI=Body Mass Index; LA=Left Atrium; LVEF=Left Ventricle Ejection Fraction; MI=Myocardial Infarction; PCI=Percutaneous Coronary Intervention; RF=Radiofrequency Figure 1. Panel A: Schematic figure illustrating anterior and posterior positions of the dispersive patch electrode. Panel B: Dispersive patches and their position in relation to the human’s heart and internal organs Figure 2. Anterior position of the dispersive patch electrode during pulmonary vein isolation Figure 3. Differences in impedances between anterior and posterior position of the dispersive patch electrode Figure 4. Differences in AF-free survival between patients undergoing pulmonary vein isolation with anterior and posterior position of the dispersive patch electrode. AF=atrial fibrillation. DPE=dispersive patch electrode. Figure 5. Comparison of AF-free survival between patients undergoing pulmonary vein isolation with and without general anaesthesia. AF=atrial fibrillation. Information & Authors Information Version history V1 Version 1 01 April 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keyword clinical: catheter ablation – atrial fibrillation Authors Affiliations Łukasz Zarębski 0000-0003-2524-7950 [email protected] St Joseph's Heart Rhythm Center View all articles by this author Mateusz A. Iwański St Joseph's Heart Rhythm Center View all articles by this author Natalia Burda St Joseph's Heart Rhythm Center View all articles by this author Agata Surowiec St Joseph's Heart Rhythm Center View all articles by this author Aleksandra Cieplińska St Joseph's Heart Rhythm Center View all articles by this author Patrycja Świerczek-Augustyn St Joseph's Heart Rhythm Center View all articles by this author Marian Futyma St Joseph's Heart Rhythm Center View all articles by this author Piotr Futyma 0000-0003-0219-7612 St Joseph's Heart Rhythm Center View all articles by this author Metrics & Citations Metrics Article Usage 200 views 100 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Łukasz Zarębski, Mateusz A. Iwański, Natalia Burda, et al. Anterior dispersive patch electrode position during pulmonary vein isolation using radiofrequency -- a pilot feasibility study. Authorea . 01 April 2025. DOI: https://doi.org/10.22541/au.174347478.88332751/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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