Identification of deliberate catheter motion at the left atrial
posterior wall during pulmonary vein isolation: Validity of respiratory
Background During automated radiofrequency (RF)
annotation-guided pulmonary vein isolation (PVI), respiratory motion
adjustment (RMA) is recommended, yet lacks in vivo validation.
Methods Following contact force (CF) PVI (continuous RF, 30W)
using general anaesthesia and automated RF annotation-guidance
(VISITAG™: force-over-time 100% minimum 1g; 2mm position stability;
ACCURESP™ RMA “off”) in 25 patients, we retrospectively examined RMA
settings “on” versus “off” at the left atrial posterior wall (LAPW).
Results Respiratory motion detection occurred in 8, permitting
offline retrospective comparison of RMA settings. Significant
differences in LAPW RF auto-annotation occurred according to RMA
setting, with curves displaying catheter position, CF and impedance data
indicating “best-fit” for catheter motion detection using RMA “off”.
Comparing RMA “on” versus “off”, respectively: Total annotated sites
82 versus 98; median RF duration per-site 13.3s versus 10.6s
(p<0.0001); median force time integral 177g.s versus 130g.s
(p=0.0002); mean inter-tag distance (ITD) 6.0mm versus 4.8mm (p=0.002).
Considering LAPW annotated site 1-to-2 transitions resulting from
deliberate catheter movement, 3 concurrent with inadvertent 0g CF
demonstrated <0.6s difference in RF duration. However, 13
deliberate catheter movements during constant tissue contact (ITD range
2.1 – 7.0mm) demonstrated (mean) site-1 RF duration difference 3.7s
(range: -1.3 to 11.3s): considering multiple measures of catheter
position instability, the appropriate indication of deliberate catheter
motion occurred with RMA “off” in all. Conclusions ACCURESP™
respiratory motion adjustment importantly delayed the identification of
deliberate and clinically relevant catheter motion during LAPW RF
delivery, rendering auto-annotated RF display invalid. Operators seeking
greater accuracy during auto-annotated RF delivery should avoid RMA use.