Impact of impedance decrease during radiofrequency current application for atrial fibrillation ablation on myocardial lesion and gap formation.

ABSTRACT

BACKGROUND: The clinical impact of a decrease in impedance during radiofrequency catheter ablation (RFCA) has not been fully clarified. The aim of the study was to analyze the impact of impedance decrease and to determine its optimal cutoff value during RFCA. METHODS: We evaluated 34 consecutive patients (total 3264 lesions, mean age 66 ± 8.7 years, 10 females) who underwent their first ablation for atrial fibrillation (AF). The impedance decrease, average contact force (CF), application time, force-time integral (FTI), product of impedance decrease and application time (PIT), and the product of impedance decrease and FTI (PIFT) were measured for all lesions. Levels of cardiac troponin I (TrpI) were measured for assessment of myocardial injury. The incidence of intraprocedural pulmonary vein-left atrium reconnection or dormant conduction (reconnection) was determined. The relationships between the ablation parameters and the increase in TrpI (ΔTrpI) were evaluated. The predictive value of the parameters for reconnection was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: Reconnection was detected in 18 patients. Average FTI and PIT were significantly correlated with ΔTrpI (FTI r2 = .19, P = .0090, PIT r2 = .21, P = .0058). PIFT was correlated with ΔTrpI and was the best of the three indexes (PIFT r2 = .29, P = .0010). In ROC curve analysis, the area under the curve for predicting reconnection was 0.71 and the optimal cutoff value was 5200 for PIFT (sensitivity 78%, specificity 63%). CONCLUSION: The combination of CF and a decrease in impedance could be important in the evaluation of myocardial lesions and reconnection during RFCA.