Ablation catheter motion detection during contact force and VISITAG™ Module-guided pulmonary vein isolation

BackgroundDuring contact force (CF) and VISITAG Module (Biosense Webster) guided pulmonary vein isolation (PVI), ACCURESP respiratory motion adjustment is recommended, although without in vivo validation.\n\nObjectiveSince accurate LAPW radiofrequency (RF) annotation is crucial to avoid oesophageal thermal injury, we compared ACCURESP setting (\"on\" versus \"off\") on RF annotation at the left atrial posterior wall (LAPW).\n\nMethodsFrom a twenty-five patient cohort undergoing CF PVI (continuous RF, 30W) using general anaesthesia and VISITAG Module annotation-guidance (force-over-time 100% minimum 1g, 2mm position stability, ACCURESP \"off\"), respiratory motion detection occurred in eight, permitting retrospective comparison of ACCURESP settings.\n\nResultsThere were significant differences in LAPW RF data annotation according to ACCURESP setting. Comparing ACCURESP \"on\" versus \"off\", respectively: Total annotated sites 82 versus 98; Median RF duration per-site 13.3s versus 10.6s (p<0.0001); Median force time integral 177g.s versus 130g.s (p=0.0002); Mean inter-lesion distance (ILD) 6.0mm versus 4.8mm (p=0.002). Considering only annotated site 1-to-2 transitions, three occurred with 0g CF; ACCURESP \"on\" minus \"off\" difference in RF duration was <0.6s. However, thirteen site 1-to-2 transitions during constant catheter-tissue contact (ILD range 2.1 - 7.0mm) demonstrated a mean difference in annotated RF duration at site 1, of 3.7s (Range: -1.3 - 11.3s). Reconstituted curves displaying catheter position data, CF, impedance and site 1-to-2 transition according to ACCURESP setting, demonstrated multiple markers of catheter movement coinciding with ACCURESP \"off\".\n\nConclusionsACCURESP \"off\" setting demonstrated excellent catheter movement detection properties and represents an optimal method towards the annotation of stable sites of RF delivery at the LAPW.