title: Detection of inadvertent catheter movement into a pulmonary vein during radiofrequency catheter ablation by real-time impedance monitoring.
abstract: BACKGROUND
  During radiofrequency ablation to encircle or isolate the pulmonary veins (PVs), applications of radiofrequency energy within a PV may result in stenosis. The aim of this study was to determine whether monitoring of real-time impedance facilitates detection of inadvertent catheter movement into a PV.
  
  
  RESULTS
  In 30 consecutive patients (mean age 53 +/- 11 years) who underwent a left atrial ablation procedure, the three-dimensional geometry of the left atrium, the PVs, and their ostia were reconstructed using an electroanatomic mapping system. The PV ostia were identified based on venography, changes in electrogram morphology, and manual and fluoroscopic feedback as the catheter was withdrawn from the PV into the left atrium. Real-time impedance was measured at the ostium, inside the PV at approximately 1 and 3 cm from the ostium, in the left atrial appendage, and at the posterior left atrial wall. There was an impedance gradient from the distal PV (127 +/- 30 Omega) to the proximal PV (108 +/- 15 Omega) to the ostium (98 +/- 11 Omega) in each PV (P < 0.01). There was no significant impedance difference between the ostial and left atrial sites. During applications of radiofrequency energy, movement of the ablation catheter into a PV was accurately detected in 80% of the cases (20) when there was an abrupt increase of >/=4 Omega in real-time impedance.
  
  
  CONCLUSIONS
  There is a significant impedance gradient from the distal PV to the left atrium. Continuous monitoring of the real-time impedance facilitates detection of inadvertent catheter movement into a PV during applications of radiofrequency energy.
authors.affiliation: Division of Cardiology, University of Michigan, Ann Arbor, Michigan 48109-0311, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Cheung
authors.forename: Burr
authors.initials: B
authors.lastname: Hall
authors.forename: Aman
authors.initials: A
authors.lastname: Chugh
authors.forename: Eric
authors.initials: E
authors.lastname: Good
authors.forename: Kristina
authors.initials: K
authors.lastname: Lemola
authors.forename: Jihn
authors.initials: J
authors.lastname: Han
authors.forename: Kamala
authors.initials: K
authors.lastname: Tamirisa
authors.forename: Frank
authors.initials: F
authors.lastname: Pelosi
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.forename: Hakan
authors.initials: H
authors.lastname: Oral
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects; D003199:Computer Systems; D017097:Electric Impedance; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome