Dielectric concept: “A Magnification Lens in EP Lab?”
Claudio Tondo, MD, PhD, FESC, FHRS
Heart Rhythm Center at Monzino Cardiac Center, IRCCS,
Department of Biomedical, Surgical and Dentistry Sciences, University of Milan, Milan, Italy.
Correspondence to:
Claudio Tondo, M.D., Ph.D., FESC, FHRS
Director, Heart Rhythm Center at
Monzino Cardiac Center, IRCCS
Department of Biomedical, Surgical and Dentist Sciences
University of Milan, Milan, Italy
Via Carlo Parea, 4 - 20138 Milan, Italy
Mail: claudio.tondo@ccfm.it; claudio.tondo@unimi.it
“Funding None”
“Conflict of Interest: None”
It is well recognized that radiofrequency (RF) energy effect, is dependent upon several variables that impact lesion size and transmurality including catheter stability, contact force, power output, temperature, duration of RF output, and tissue characteristics and thickness. The notion that tissue thickness can impair the effectiveness of RF ablation is well known from experimental studies (1) and this again might have a role in the durability of lesions. Many advances in catheter technology have recently shown the potential to transform the approach to arrhythmia ablation and to improve its completeness in terms of transmurality and durability of the sets of lesions created. However, the chance to tailor RF delivery according to myocardial thickness is still lacking. A new dielectric-based method (KODEX-EPD mapping system, EPD Solutions, a Philips company) for measuring tissue thickness at the catheter- tissue interface has recently been developed. This should provide significant information on tissue thickness in different cardiac areas and, theoretically provide clue for titrating power aiming at the most effective lesion formation. In this issue of the Journal, Schillaci et al. (2) reported preliminary data on real-time catheter-based measuring myocardial wall thickness in vivo, during typical atrial flutter (AFL) RF ablation in a small group of patients. Importantly, they used a KODEX version (1.5.0.30.) not commercially available yet but only for case replay and research purpose. Therefore, this study represents a preliminary attempt to describe in real time how the myocardial wall tissue can affect the RF energy delivering.