Simultaneous assessment of contact pressure and local electrical coupling index using robotic navigation

作者：Dello Russo Antonio; Fassini Gaetano; Casella Michela^*; Bologna Fabrizio; Al Nono Osama; Colombo Daniele; Biagioli Viviana; Santangeli Pasquale; Di Biase Luigi; Zucchetti Martina; Majocchi Benedetta; Marino Vittoria; Gallinghouse Joseph J; Natale Andrea; Tondo Claudio

来源：Journal of Interventional Cardiac Electrophysiology, 2014, 40(1): 23-31.

DOI：10.1007/s10840-014-9882-2

• Atrial fibrillation
• Catheter ablation
• Radiofrequency
• Electrical coupling index
• Catheter tip-to-tissue contact

Contact with cardiac tissue is a determinant of lesion efficacy during atrial fibrillation (AF) ablation. The SenseiA (R) X Robotic Catheter System (Hansen Medical, CA) has been validated for contact force sensing. The electrical coupling index (ECI) from the EnSite Contact (TM) system (St. Jude Medical, MN) has been validated as an indicator of tissue contact. We aimed at analyzing ECI behavior during radiofrequency (RF) pulses maintaining a stable contact through the robotic navigation contact system.
In 15 patients (age, 59 +/- 12) undergoing AF ablation, pulmonary vein (PV) isolation was guided by the SenseiA (R) X System, employing the Contact (TM) catheter.
During the procedure, we assessed ECI changes associated with adequate contact based on the IntelliSenseA (R) force-sensing technology (Hansen Medical, CA. Baseline contact (27 A +/- 8 g/cm(2)) ECI value was 99 A +/- 13, whereas ECI values in a noncontact site (0 g/cm(2)) and in a light contact site (1-10 g/cm(2)) were respectively 66 A +/- 12 and 77 A +/- 10 (p < 0.0001). Baseline contact ECI values were not different depending on AF presentation (paroxysmal AF, 98 A +/- 9; persistent AF, 100 A +/- 9) or on cardiac rhythm (sinus rhythm, 97 A +/- 7; AF,101 A +/- 10). In all PVs, ECI was significantly reduced during and after ablation (ECI during RF, 56 A +/- 15; ECI after RF, 72 A +/- 16; p < 0.001). A mean reduction of 32.2 % during RF delivery and 25.4 % immediately after RF discontinuation compared with baseline ECI was observed.
Successful PV isolation is associated with a significant decrease in ECI of at least 20 %. This may be used as a surrogate marker of effective lesion in AF ablation.

• 出版日期2014-6