90 Investigating the tissue response to radiofrequency ablation during left atrial posterior wall ablation: analysis of unipolar electrogram morphological changes following visitag-guided pulmonary vein isolation

Background: Atrio-oesophageal fistula (AOF) is a rare complication of radiofrequency (RF) pulmonary vein isolation (PVI) but with mortality>50%. Worryingly, from an analysis of the FDA MAUDE database, the percentage of reported AOF cases was 6 times greater with the use of contact force (CF) sensing compared to non-CF sensing catheters (Heart Rhythm, article in press). Assessment of morphological change in the unipolar electrogram (UE) during RF may facilitate left atrial posterior wall (LAPW) ablation, since change from RS to pure R was 100% predictive of histologically confirmed transmural (TM) atrial ablation in a porcine model. Furthermore, during canine atrial CF ablation, UE pure R was demonstrated following just 7s irrigated RF at 30W, with 95% resulting lesions TM to a depth of 4.3mm. However, while greater RF duration resulted in 100% TM lesions, there was a significant increase in the risk of extra-cardiac thermal injury. Here I report LAPW UE morphology changes following VISITAG ™-guided PVI, using CARTOREPLAY™. 
Source: Europace - Category: Cardiology Source Type: research