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Identification of deliberate catheter motion at the left atrial posterior wall during pulmonary vein isolation: Validity of respiratory motion adjustment
Author(s) -
Tomlinson David R.,
Biscombe Katie,
True John,
Hosking Joanne,
Streeter Adam J.
Publication year - 2021
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.14945
Subject(s) - medicine , catheter , pulmonary vein , nuclear medicine , cardiology , surgery , atrial fibrillation
Background During automated radiofrequency (RF) annotation‐guided pulmonary vein isolation (PVI), respiratory motion adjustment (RMA) is recommended, yet lacks in vivo validation. Methods Following contact force (CF) PVI (continuous RF, 30 W) using general anesthesia and automated RF annotation‐guidance (VISITAG™: force‐over‐time 100% minimum 1 g; 2 mm position stability; ACCURESP™ RMA “off”) in 25 patients, we retrospectively examined RMA settings “on” versus “off” at the left atrial posterior wall (LAPW). Results Respiratory motion detection occurred in eight, permitting offline retrospective comparison of RMA settings. Significant differences in LAPW RF auto‐annotation occurred according to RMA setting, with curves displaying catheter position, CF and impedance data indicating “best‐fit” for catheter motion detection using RMA “off.” Comparing RMA “on” versus “off,” respectively: total annotated sites, 82 versus 98; median RF duration per‐site, 13.3 versus 10.6 s ( p < 0.0001); median force time integral 177 versus 130 gs ( p = 0.0002); mean inter‐tag distance (ITD), 6.0 versus 4.8 mm ( p = 0.002). Considering LAPW annotated site 1‐to‐2 transitions resulting from deliberate catheter movement, 3 concurrent with inadvertent 0 g CF demonstrated < 0.6 s difference in RF duration. However, 13 deliberate catheter movements during constant tissue contact (ITD range: 2.1–7.0 mm) demonstrated (mean) site‐1 RF duration difference 3.7 s (range: −1.3 to 11.3 s): considering multiple measures of catheter position instability, the appropriate indication of deliberate catheter motion occurred with RMA “off” in all. Conclusions ACCURESP™ respiratory motion adjustment importantly delayed the identification of deliberate and clinically relevant catheter motion during LAPW RF delivery, rendering auto‐annotated RF display invalid. Operators seeking greater accuracy during auto‐annotated RF delivery should avoid RMA use.