{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T02:06:10Z","timestamp":1790474770796,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T00:00:00Z","timestamp":1650585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Although radiofrequency (RF) catheter ablation of cavo\u2010tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL), it remains to be established whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective. We aimed to investigate the ability of LI to predict ablation efficacy in patients with RAFL.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>RF delivery was guided by the DirectSense\u2122 algorithm. Successful single RF application was defined according to a defragmentation of atrial potentials (DAP), reduction of voltage (RedV) by at least 80% or changes on unipolar electrogram (UPC). The ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>392 point\u2010by\u2010point RF applications were analyzed in 48 consecutive RAFL patients. The mean baseline LI was 105.4\u00a0\u00b1\u00a012\u03a9 prior to ablation and 92.0\u00a0\u00b1\u00a011\u03a9 after ablation (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001). According to validation criteria, absolute drops in impedance were larger at successful ablation sites than at ineffective ablation sites (DAP: 17.8\u00a0\u00b1\u00a06\u03a9 vs. 8.7\u00a0\u00b1\u00a04\u03a9; RedV: 17.2\u00a0\u00b1\u00a06\u03a9 vs. 7.8\u00a0\u00b1\u00a05\u03a9; UPC: 19.6\u00a0\u00b1\u00a06\u03a9 vs. 10.1\u00a0\u00b1\u00a05\u03a9, all <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.0001). LI drop values significantly increased according to the number of criteria satisfied (ranging from 7.5\u03a9 to 19.9). BDB was obtained in all cases. No procedure\u2010related adverse events were reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A LI\u2010guided approach to CTI ablation was safe and effective in treating RAFL. The magnitude of LI drop was associated with effective lesion formation and BDB and could be used as a marker of ablation efficacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p>Catheter Ablation of Arrhythmias with a High\u2010Density Mapping System in Real\u2010World Practice (CHARISMA). URL: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\/\">http:\/\/clinicaltrials.gov\/<\/jats:ext-link> Identifier: NCT03793998.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14482","type":"journal-article","created":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T08:54:55Z","timestamp":1649148895000},"page":"612-618","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Optimized radiofrequency lesions through local impedance guidance for effective CTI ablation in right atrial flutter"],"prefix":"10.1111","volume":"45","author":[{"given":"Valentino","family":"Ducceschi","sequence":"first","affiliation":[{"name":"Pellegrini Hospital  Naples Italy"},{"name":"Buon Consiglio Fatebenefratelli Hospital Division of Cardiology  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Zingarini","sequence":"additional","affiliation":[{"name":"Santa Maria della Misericordia Hospital  Perugia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Nigro","sequence":"additional","affiliation":[{"name":"Department of Cardiology Monaldi Hospital  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Maria Angelo","family":"Brasca","sequence":"additional","affiliation":[{"name":"ASST Rhodense Civile Hospital Rho and Salvini Hospital Garbagnate Milanese Hospital  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8823-0334","authenticated-orcid":false,"given":"Maurizio","family":"Malacrida","sequence":"additional","affiliation":[{"name":"Boston Scientific  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Carbone","sequence":"additional","affiliation":[{"name":"Maria SS. Addolorata Hospital  Eboli Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0794-4296","authenticated-orcid":false,"given":"Carlo","family":"Lavalle","sequence":"additional","affiliation":[{"name":"Umberto I Hospital  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giampiero","family":"Maglia","sequence":"additional","affiliation":[{"name":"Pugliese\u2010Ciaccio Hospital  Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Infusino","sequence":"additional","affiliation":[{"name":"Sant'Anna Hospital  Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Aloia","sequence":"additional","affiliation":[{"name":"Division of Cardiology Presidio Ospedaliero di Vallo della Lucania  Vallo della Lucania 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