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Electrogram Characteristics of Ablated and Non‐Ablated Myocardium in Humans: A Comparison of Miniaturized Embedded Electrodes and Conventional Ablation Electrodes
Author(s) -
LLOYD MICHAEL S.,
HOSKINS MICHAEL H.,
SHAH ANAND D.,
LANGBERG JONATHAN J.
Publication year - 2016
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12980
Subject(s) - ablation , medicine , atrial flutter , radiofrequency ablation , electrode , lesion , intracardiac injection , voltage , cardiology , biomedical engineering , nuclear medicine , surgery , electrical engineering , chemistry , engineering
Embedded Electrode Ablation Introduction Intracardiac electrogram voltage remains an important metric for radiofrequency lesion application. Embedded micro‐electrodes within ablation catheters are now approved for use in humans. Objective This study examined electrogram characteristics of miniaturized electrode bipoles (iEGM mini ) compared to distal ablation tip bipoles (iEGM standard ) in the setting of typical atrial flutter in humans. Methods This was a single‐center prospective trial involving 21 patients. A total of 54 non‐ablated and 56 ablated sites were analyzed offline by separate blinded observers for iEGM voltage after a clinically successful radiofrequency (RF) ablation for typical atrial flutter. Ablation sites were defined as sites that were localized anatomically within the RF lesion set and did not have atrial capture at 10 mA and 2 milliseconds. Non‐ablated sites were defined as sites adjacent to or remote from the ablation lesion set with capture at 10 mA and 2 milliseconds. Results iEGM mini had greater voltages at non‐ablated sites and lower voltages at ablated sites than iEGM standard (non‐ablated sites iEGM standard 0.64 mV vs. iEGM mini 1.0 mV; ablated sites iEGM standard 0.15 mV, iEGM mini 0.08 mV, P < 0.001). The difference for each patient between ablated and non‐ablated sites was greater for iEGM mini compared to iEGM standard (0.94 mV ± 0.57 iEGM mini vs. 0.52 mV ± 0.35 iEGM standard , P < 0.001). Inter‐observer agreement was good among all non‐ablated sites and iEGM mini ablated sites, but was less robust for ablated sites using iEGM standard . Conclusions Imbedded mini‐electrode iEGM bipoles had higher voltages in non‐ablated tissue, lower voltages in ablated tissue, and significantly greater intra‐patient differences between ablated and non‐ablated sites. These data suggest a potential role for miniaturized electrode bipole use in RF lesion monitoring.