Local multifrequency impedance changes after radiofrequency ablation in human atria: Potential use for tissue characterization

Gerard Amorós-Figueras^1*Zoraida Moreno Weidmann¹Francisco Mendez-Zurita¹Marc Soriano-Amores¹Ramon Bragos²Javier Rosell-Ferrer²Jose M. Guerra¹

• ¹Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau (IR SANT PAU), CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
• ²Universitat Politecnica de Catalunya Departament d'Enginyeria Electronica, Barcelona, Spain

Background: Local impedance (LI) mapping provides additional tissue characterization of the atria substrate. The measurement ofMeasuring LI at different current frequencies has the advantage of exploring intra-and extra-cellular compartments and may add useful information about tissue integrity. The objective of this study was to characterize the changes in local multifrequency impedance (LMI) after radiofrequency ablation in human atrial tissue. Methods: In fifteen patients undergoing catheter ablation of atrial arrhythmias, we constructed a baseline high-density electroanatomical map (EAM) and measured the LMI (1-1000 kHz) at fifty sites around the cava veins using the QDOT or Smarttouch electrocatheter.In fifteen patients , a baseline high-density electroanatomical mapping (EAM) was constructed with LMI measurements in the left atria from 1 to 1000 kHz. Then a point-by-point pulmonary vein isolation procedure was performed using radiofrequency energy in a temperature controlled mode (90W for 4s for QDOT/ 30W for 30s for Smarttouch). After confirming the PVI fifty additional LMI recordings per patient were performed around the initial sites.Temperature-controlled point-by-point pulmonary vein isolation using radiofrequency ablation was performed, followed by EAM and LMI remapping. We performed an offline analysis to compare the values of bipolar voltage andLMI of blood, pre-and post-ablated tissue. We also analyzed the cardiac cycle changes of LMI and the effects of catheter orientation to the LMI, contact force and bipolar voltage. Results: A total of 641 pre-ablated and 190 post-ablated sites were studied from all patients. Blood pool, healthy and post-ablated myocardium presented distinctive LMI signatures (ZPRE=110±15 Ω vs. ZPOST=90±10 Ω vs. ZBLOOD=90±8 Ω; p<0.001). LMI cyclic changes showed an inverse relationship with the contact force, and these were more attenuated in the post-ablated tissue (p<0.001). Conclusions: LMI can differentiate pre-from post-ablated tissue in a cohort of patients submitted to RF ablations. This new tool could be of potential clinical applicability for the characterization of the atrial substrate and to monitor lesion quality to perform durable ablation lesions. Clinical Trial Registration: NCT05159180 (clinicaltrials.gov); Unique Protocol ID: IIBSP-IMS-2021-74.