How to leverage local impedance to guide effective ablation strategy: A case series

摘要

Left: The propagation map acquired with the Orion™ catheter (Boston Scientific, Marlborough, MA) revealed a single gap (dark red front) reconnecting both left veins. The electrograms detected by the Orion catheter at the gap location were highly fragmented and well represented. Right: The tip of the ablation catheter is at the gap location, as indicated by the white halo on the activation map. The real-time signal graph on the left shows both Orion signals (with far-field and pulmonary vein components) and ablation traces. Conventional ablation traces show no signals (white traces in the red rectangle) while mini-electrode tracings (yellow traces in the red rectangle) show very tiny and barely visible signals that are completely different from those previously detected by the Orion catheter at the same spot. The red rectangle on the right of the panel shows the real-time local impedance (LI) value when the catheter tip was at the location indicated by the white halo. This impedance value is more compatible with a conduction gap than with unexcitable tissue.