Clinical implications of local impedance measurement using the IntellaNav MiFi OI ablation catheter: an ex vivo study

Clinical implication of local impedance (LI) for radiofrequency (RF) ablation has not been fully established. This study aimed to investigate this point using IntellaNav MiFi OITM catheter. LI and generator impedance drops (ΔLI and ΔGI) were evaluated in excised porcine hearts (N = 16) during RF applications at a range of powers (30 and 50 W), contact forces (5–40 g), and durations (10–180 s) using perpendicular or parallel catheter orientation. Additionally, temporal LI changes were assessed. Of the 240 lesions without steam pops (92.3%), ΔLI showed better correlations with lesion surface area (ρ = 0.55 vs 0.36, P = 0.004), maximum depth (ρ = 0.53 vs 0.14, P < 0.001), and lesion volume (ρ = 0.64 vs 0.23, P < 0.001) than ΔGI. Furthermore, %LI-drop (ΔLI/initial LI) demonstrated stronger correlations with lesion surface area (ρ = 0.60 vs 0.55, P < 0.001), maximum depth (ρ = 0.57 vs 0.53, P < 0.001), and volume (ρ = 0.69 vs 0.64, P < 0.001) than ΔLI. Parallel catheter orientation improved correlation of ΔLI with lesion surface area (ρ = 0.63 vs 0.40, P = 0.015) and depth (ρ = 0.68 vs 0.45, P = 0.008) and created a larger surface lesion (36.3[29.2–42.7] mm2 vs 28.8[21.6–34.2] mm2, P < 0.001) than the perpendicular. LI of the lesions significantly differed between baseline, immediately after RF, and 5 min after (P < 0.01). LI reaching plateau, larger initial LI, ΔLI, and %LI-drop, and larger RF power and longer duration were observed in pop lesions (P < 0.05). %LI-drop demonstrated a better correlation with lesion size than ΔLI. LI may be used as an additional parameter to predict lesion size and steam pops. Temporal variation and catheter orientation should be considered to interpret LI.