Initial experience with dielectric-based local tissue assessment for catheter ablation

Abstract

Abstract Background Dielectric imaging systems can be used to guide catheter ablation for cardiac arrhythmia. Currently, the KODEX-EPD system can be used to acquire high-resolution anatomical data for electroanatomical mapping. Future software versions of this system enable tissue assessment utilizing local dielectric sensing. These dielectric-based tissue assessments (KODEX Vision) enable new features, including wall thickness measurement, catheter-tissue contact assessment, and ablation lesion assessment. Purpose To gain insight in the dielectric-based tissue assessment features. Methods The KODEX-EPD system was used to perform repeat ablations in patients with recurrent atrial fibrillation after pulmonary vein isolation. A primary system with the current software version (1.4.8) was used by the operator. Ablation was performed with a non-contact force-sensing irrigated radiofrequency catheter, with power set at 30–35W and aiming for ablation times of 30–60s. A secondary system was blinded for the operator and loaded with beta software (1.5.0) to enable the KODEX Vision features. Only successful local tissue assessments are presented in this abstract. All patients were enrolled in a prospective registry study which was approved by the local ethics committee. Results Electroanatomic mapping in 25 patients (age 65±8yr, male 84%, LAVI 31±9ml/m2) revealed electrical reconnection in 66 of 100 pulmonary veins. A total of 308 radiofrequency applications were used to re-isolate the veins and create additional lesions (superior vena cava isolation in 6, box lesion in 1). Wall thickness at the sites of ablation ranged from 1.3–3.9 mm. Tissue contact assessment at the start of RF applications indicated “touch” in 77%, while 17.5% and 5.5% of results indicated `no touch' or “high touch”. Tissue Response Viewer indicated low dielectric response in 18.5% and high dielectric response in 81.5% of results. High dielectric response was associated with lower wall thickness (OR: 0.86, 95% CI [0.76–0.97], p=0.014). Conclusion This preliminary evaluation underlines the potential of dielectric-based tissue assessment features. Wall thickness measurement, catheter-tissue contact, and ablation lesion assessment seem feasible with the beta software. Further evaluation of the feasibility, accuracy and clinical impact of the finalized software is warranted. Funding Acknowledgement Type of funding sources: None.