Introduction
The central importance of electrical pulmonary vein isolation (PVI)
towards eliminating atrial fibrillation (AF) is
well-established.1,2 Important progress towards
improving procedural success was recently reported using site-specific
contact force (CF) radiofrequency (RF) energy delivery targets, defined
using a weighted formula incorporating RF power, CF and duration
(Ablation Index, AI, Biosense Webster Inc., Diamond Bar,
CA).3,4 This entire experimental approach was
underpinned by a process of automated RF annotation (VISITAG™ Module,
Biosense Webster), targeting a minimum inter-tag distance (ITD) of 6mm.
However, this may represent an imperfect description of a genuinely
reproducible PVI protocol, since – employing either conscious sedation
or general anaesthesia (GA) with intermittent positive pressure
ventilation (IPPV) – these studies5 routinely applied
end-expiratory respiratory motion adjustment (RMA) to automated RF
annotation settings (i.e. ACCURESP™ “on”). Importantly, such RMA use
remains without in vivo validation. Therefore, in view of the
importance of accurate RF auto-annotation at the LAPW due to the
site-specific risk of atrio-oesophageal fistula (AEF), we
retrospectively investigated the effects of RMA use on LAPW automated RF
annotation, following CF-guided PVI.