In Vivo Left-ventricular Contact Force Analysis: Comparison of Antegrade Transseptal with Retrograde Transaortic Mapping Strategies and Correlation of Impedance and Electrical Amplitude with Contact Force

Overview

Journal Europace

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Physiology

Date 2014 Feb 5

PMID 24493339

Citations 21

Authors

Roland Richard Tilz

Hisaki Makimoto

Tina Lin

Andreas Rillig

Andreas Metzner

Shibu Mathew

Sebastian Deiss

Erik Wissner

Peter Rausch

Masashi Kamioka

Christian Heeger

Karl-Heinz Kuck

Feifan Ouyang

Affiliations

Soon will be listed here.

Abstract

Aims: Clinical outcomes following radiofrequency ablation of ventricular tachycardias (VTs) depend on catheter tip-to-tissue contact force (CF). Left-ventricular (LV) mapping is performed via antegrade-transseptal or retrograde-transaortic approaches, and the applied CF may depend on the approach used. This study evaluated (i) the impact of antegrade-transseptal vs. retrograde-transaortic LV-mapping approaches on CF and catheter stability and (ii) the clinical value of the commonly used surrogate markers of catheter-myocardial contact-impedance, unipolar, and bipolar electrogram amplitudes.

Methods And Results: An antegrade-transseptal and a retrograde-transaortic LV-mapping approach was performed in 10 patients undergoing VT ablation by using CF-sensing catheters. Operators were blinded to CF data and data were analysed according to 11 predefined LV segments. Three thousand three hundred and twenty-four mapping points (1577 antegrade, 1747 retrograde) were analysed, including 80 (2.4%) points with maximum CF > 100 g. Median antegrade and retrograde CF were 16.0 g (q1-q3; 8.4-26.2) and 15.3 g (9.8-23.4), respectively. Contact force was significantly higher antegradely in mid-anteroseptum, mid-lateral, and apical segments, and significantly higher retrogradely in basal-anteroseptum, basal-inferoseptum, basal-inferior, and basal-lateral segments. Contact force did correlate with impedance, unipolar, and bipolar electrogram amplitudes; however, there were large overlaps.

Conclusions: Antegrade vs. retrograde LV-mapping approaches result in different CF. A combined approach to the LV mapping may improve the overall LV mapping, potentially resulting in better clinical outcomes for the left VT catheter ablation. The previous surrogate markers used to assess CF do correlate with in vivo CF; however, due to a larger overlap, their clinical value is limited.

Citing Articles

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