Author + information
- Received April 4, 2019
- Revision received October 9, 2019
- Accepted October 10, 2019
- Published online November 27, 2019.
- Kennosuke Yamashita, MD, PhDa,b,
- Roya Kamali, MSa,b,c,
- Eugene Kwan, BSa,b,c,
- Rob S. MacLeod, PhDb,c,
- Derek J. Dosdall, PhDa,b,c,d and
- Ravi Ranjan, MD, PhDa,b,c,∗ ()
- aDivision of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- bNora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
- cDepartment of Bioengineering, University of Utah, Salt Lake City, Utah
- dDivision of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
- ↵∗Address for correspondence:
Dr. Ravi Ranjan, Cardiovascular Medicine, University of Utah, 30 North 1900 East, Room 4A100, Salt Lake City, Utah 84132-2101.
Objectives The goal of this study was to find effective parameters that can be used in real-time that result in chronic scar verified by left atrial (LA) late gadolinium enhancement cardiac magnetic resonance (LGE-CMR).
Background Automated annotation can be a useful tool while ablating in tagging areas that will result in scar, but the effective settings that best predict chronic scar are still unknown.
Methods Patients underwent pulmonary vein isolation using a CARTO3 mapping system with a VISITAG Module and 3-month post-ablation LGE-CMR. The electroanatomical map (EAM) was used to retrospectively tag ablated areas with 5 different parameters: catheter stability; stability duration; force over time; minimum contact force; and impedance drop. The ablation tags in EAM were projected to the 3-month post-ablation LGE-CMR. Tags were divided into 2 groups depending on if they correlated with CMR-based scar tags (STAGs) or nonscar tags (NTAGs); the effective parameters were estimated for the 2 groups at different power levels.
Results This study assessed 70 consecutive patients and 28,939 ablation tags. Ablation time and force time integral (FTI) were significantly larger in the STAG group. Mean contact force, change of catheter tip temperature, and impedance were not significantly different between STAGs and NTAGs. The minimum ablation time and FTI to make durable scar lesions were 17.6, 13.6, and 11.0 s and 226.1, 187.4, and 161.4 g at 25, 35, and 50 W, respectively.
Conclusions Minimum ablation time and FTI values are critical parameters that determine durable atrial scar creation and their minimum values vary with the ablation power setting.
Dr. Ranjan is supported by that National Institutes of Health (grant R01 HL142913). Dr. MacLeod is a member of the Mathematical Advisory Board for EP Solutions; and has received research support from Medtronic and Catheter Precision. Dr. Ranjan has received research grants from Medtronic, Abbott and Biosense Webster; and has been a consultant for Medtronic and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 4, 2019.
- Revision received October 9, 2019.
- Accepted October 10, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.