Three-dimensional impedance mapping as an aid to circumferential pulmonary vein isolation in paroxysmal atrial fibrillation.
During circumferential pulmonary vein isolation, radiofrequency lesions are created in the transition zone between the left atrium and the pulmonary veins, outside the ostia, to avoid stenosis. Three-dimensional impedance maps were constructed for 25 patients with paroxysmal atrial fibrillation. In the first 15 patients, impedance was measured inside the pulmonary veins (165.4 +/- 7.5 Omega), the ostium (141.6 +/- 7.3 Omega) and the left atrium (131.09 +/- 8.3 Omega). An impedance of 136 Omega identified the outer limit of the atrium (area under the receiver operating characteristic curve, 0.85). In the subsequent 10 patients, a single operator who was blinded to the anatomic position of the catheter tip was able to determine, by impedance measurement alone, whether the point targeted for radiofrequency ablation was in the left atrium or the ostium of the pulmonary vein. The positive predictive value for identifying the left atrium was 91% and the negative predictive value was 73%. In patients with paroxysmal atrial fibrillation, three-dimensional impedance mapping was helpful in guiding circumferential pulmonary vein isolation.
Pedrote
Alonso
A
Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen del Rocío, 41013 Sevilla, Spain. pedroteal@hotmail.com
Arana-Rueda
Eduardo
E
García-Riesco
Lorena
L
Jiménez-Velasco
Adriano
A
Sánchez-Brotons
Juan
J
Arizón-Muñoz
José M
JM
Fernández-Pérez
José M
JM
Frutos-López
Manuel
M
D001281:Atrial Fibrillation / Q000601:surgery*; D002307:Cardiography, Impedance / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000033:anatomy & histology* / Q000601:surgery*; D012372:ROC Curve; D014057:Tomography, X-Ray Computed