TY - JOUR
T1 - Local atrial bipolar electrogram voltage drops during cardiac magnetic resonance guided catheter ablation of typical atrial flutter
T2 - Associations with delivered radiofrequency energy and peri-procedural imaging
AU - Nies, Hedwig M.J.M.
AU - Linz, Dominik
AU - Bijvoet, Geertruida P.
AU - Holtackers, Robert J.
AU - Luermans, Justin G.L.M.
AU - van der Velden, Kim E.H.M.
AU - Wildberger, Joachim E.
AU - Vernooy, Kevin
AU - van Kuijk, Sander M.J.
AU - Mihl, Casper
AU - Chaldoupi, Sevasti Maria
N1 - Publisher Copyright:
© 2024 Heart Rhythm Society
PY - 2024/11
Y1 - 2024/11
N2 - Background: Cardiac magnetic resonance (CMR)-guided catheter ablation of the cavotricuspid isthmus (CTI) has been proven feasible, but determinants of local electrogram (EGM) voltage drops during radiofrequency (RF) applications are unknown. Objective: The purpose of this study was to investigate local atrial bipolar EGM voltage drops and the association with delivered RF energy and anatomical information derived from peri-procedural CMR imaging. Methods: In consecutive patients undergoing CMR-guided CTI ablation procedures, relative EGM voltage drops for RF applications ≥20 seconds were calculated. Pre- and post-ablation CMR imaging was performed. Associations of relative EGM voltage drops with patient characteristics, delivered RF energy, and CTI anatomy were analyzed. Results: In total, 216 RF applications were evaluated from 12 patients (18 ± 5 applications/patient). EGM voltage amplitude at baseline was significantly higher in the group with the strongest relative EGM voltage drop (P < .05), whereas RF ablation settings (duration, power, temperature) and lesion characteristics (impedance drop, slope of impedance drop) did not differ. The EGM voltage amplitude at baseline (P < .001), left ventricular ejection fraction (LVEF) (P = .020), right atrium volume index (RAVI) (P = .027), and CTI line length (P = .026) showed the strongest association with relative EGM voltage drop. Four of 12 patients (33%) underwent a re-do procedure, 2 patients showed a regional late reconnection, which could be visually identified in the T
2-weighted images (T2WI) of the index procedure. Conclusion: Local EGM voltage amplitude, LVEF, RAVI, and CTI length are associated with relative EGM voltage drop during CMR-guided CTI ablation. Post-ablation CMR imaging during the index procedure may help to identify areas of late reconnection.
AB - Background: Cardiac magnetic resonance (CMR)-guided catheter ablation of the cavotricuspid isthmus (CTI) has been proven feasible, but determinants of local electrogram (EGM) voltage drops during radiofrequency (RF) applications are unknown. Objective: The purpose of this study was to investigate local atrial bipolar EGM voltage drops and the association with delivered RF energy and anatomical information derived from peri-procedural CMR imaging. Methods: In consecutive patients undergoing CMR-guided CTI ablation procedures, relative EGM voltage drops for RF applications ≥20 seconds were calculated. Pre- and post-ablation CMR imaging was performed. Associations of relative EGM voltage drops with patient characteristics, delivered RF energy, and CTI anatomy were analyzed. Results: In total, 216 RF applications were evaluated from 12 patients (18 ± 5 applications/patient). EGM voltage amplitude at baseline was significantly higher in the group with the strongest relative EGM voltage drop (P < .05), whereas RF ablation settings (duration, power, temperature) and lesion characteristics (impedance drop, slope of impedance drop) did not differ. The EGM voltage amplitude at baseline (P < .001), left ventricular ejection fraction (LVEF) (P = .020), right atrium volume index (RAVI) (P = .027), and CTI line length (P = .026) showed the strongest association with relative EGM voltage drop. Four of 12 patients (33%) underwent a re-do procedure, 2 patients showed a regional late reconnection, which could be visually identified in the T
2-weighted images (T2WI) of the index procedure. Conclusion: Local EGM voltage amplitude, LVEF, RAVI, and CTI length are associated with relative EGM voltage drop during CMR-guided CTI ablation. Post-ablation CMR imaging during the index procedure may help to identify areas of late reconnection.
KW - Ablation lesion assessment
KW - Atrial flutter
KW - Durable ablation lesion formation
KW - Interventional cardiac MRI (iCMR)
KW - Late electrical reconnection
KW - Local atrial bipolar electrogram
KW - Radiofrequency catheter ablation
U2 - 10.1016/j.hroo.2024.08.015
DO - 10.1016/j.hroo.2024.08.015
M3 - Article
SN - 2666-5018
VL - 5
SP - 778
EP - 787
JO - Heart Rhythm O2
JF - Heart Rhythm O2
IS - 11
ER -