Impact of a formula combining local impedance and conventional
parameters on lesion size prediction
Abstract
Background: Although ablation energy (AE) and force-time integral (FTI)
are well-known active predictors of lesion characteristics, these
parameters do not reflect passive tissue reactions during ablation,
which may instead be represented by drops in local impedance (LI). This
study aimed to investigate if additional LI-data improves predicting
lesion characteristics and steam-pops. Methods: RF applications at a
range of powers (30W, 40W, and 50W), contact forces (8g, 15g, 25g, and
35g), and durations (10-180s) using perpendicular/parallel catheter
orientations, were performed in excised porcine hearts (N=30). The
correlation between AE, FTI and lesion characteristics was examined and
the impact of LI (%LI-drop [%LID] defined by the ΔLI/Initial LI)
was additionally assessed. Results: 375 lesions without steam-pops were
examined. Ablation energy (W*s) and FTI (g*s) showed a positive
correlation with lesion depth (ρ=0.824:P<0.0001 and
ρ=0.708:P<0.0001), surface area (ρ=0.507:P<0.0001
and ρ=0.562:P<0.0001) and volume (ρ=0.807:P<0.0001
and ρ=0.685:P<0.0001). %LID also showed positive correlation
individually with lesion depth (ρ=0.643:P<0.0001), surface
area (ρ=0.547:P<0.0001) and volume (ρ=0.733,
P<0.0001). However, the combined indices of AE*%LID and
FTI*%LID provided significantly stronger correlation with lesion depth
(ρ=0.834:P<0.0001 and ρ=0.809P<0.0001), surface area
(ρ=0.529:P<0.0001 and ρ=0.656:P<0.0001) and volume
(ρ=0.864:P<0.0001 and ρ=0.838:P<0.0001). This
tendency was observed regardless of the catheter placement
(parallel/perpendicular). AE (P=0.02) and %LID (P=0.002) independently
remained as significant predictors to predict steam-pops (N=27).
However, the AE*%LID did not increase the predictive power of
steam-pops compared to the AE alone. Conclusion: LI, when combined with
conventional parameters (AE and FTI), may provide stronger correlation
with lesion characteristics.