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

• Published in: Journal of interventional cardiac electrophysiology Vol. 40; no. 1; pp. 23 - 31
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.06.2014; Springer Nature B.V
• Subjects: Aged; Atrial Fibrillation - surgery; Cardiology; Catheter Ablation - instrumentation; Catheter Ablation - methods; Electric Impedance; Electrophysiologic Techniques, Cardiac; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Multimedia Report; Plethysmography, Impedance - methods; Pressure; Robotics; Surgery, Computer-Assisted; Radiofrequency; Atrial fibrillation; Catheter ablation; Electrical coupling index; Catheter tip-to-tissue contact
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-014-9882-2

Purpose Contact with cardiac tissue is a determinant of lesion efficacy during atrial fibrillation (AF) ablation. The Sensei®X Robotic Catheter System (Hansen Medical, CA) has been validated for contact force sensing. The electrical coupling index (ECI) from the EnSite Contact™ 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. Methods In 15 patients (age, 59 ± 12) undergoing AF ablation, pulmonary vein (PV) isolation was guided by the Sensei®X System, employing the Contact™ catheter. Results During the procedure, we assessed ECI changes associated with adequate contact based on the IntelliSense® force-sensing technology (Hansen Medical, CA. Baseline contact (27 ± 8 g/cm 2 ) ECI value was 99 ± 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 ± 12 and 77 ± 10 ( p  < 0.0001). Baseline contact ECI values were not different depending on AF presentation (paroxysmal AF, 98 ± 9; persistent AF, 100 ± 9) or on cardiac rhythm (sinus rhythm, 97 ± 7; AF,101 ± 10). In all PVs, ECI was significantly reduced during and after ablation (ECI during RF, 56 ± 15; ECI after RF, 72 ± 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. Conclusions 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.