Comparison of lesion formation between contact force-guided and non-guided circumferential pulmonary vein isolation: A prospective, randomized study

Kimura, Masaomi; Sasaki, Satoshi; Owada, Shigeki; Horiuchi, Daisuke; Sasaki, Kenji; Itoh, Taihei; Ishida, Yoshiteru; Kinjo, Takahiko; Tomita, Hirofumi; Okumura, Ken

doi:10.1016/j.hrthm.2014.03.019

Cited by 118 publications

(84 citation statements)

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“…20 Kimura et al demonstrated the effectiveness of CF monitoring during PV isolation in paroxysmal AF. 21 A TOCCATA study reported that AF recurrence was universally noted when average CF was <10 g and maintenance of sinus rhythm was best achieved when average CF was >20 g. 20 We showed that PV isolation done with CF of 10-20 g significantly reduced AF recurrence in paroxysmal AF compared with the procedure without CF monitoring. 22 A TOCCASTAR study compared the outcomes of CF-vs. non-CF-guided catheter ablation in a prospective, randomized study, and demonstrated that when optimal CF (≥90% ablations with CF ≥10 g) was obtained, CF-guided ablation was associated with improved effectiveness compared with non-CF-guided ablation.…”

Section: Endpoint Of Pvimentioning

confidence: 88%

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―

Okamatsu

Okumura

2018

Circ J

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ablation lesion. These novel technologies will promisingly bring new strategies of ablation and enhanced effectiveness and safety. Here, we review the previous reports on catheter ablation for persistent AF, and then introduce possible strategies for persistent AF ablation under concomitant use of the new technologies. Previous Reports on Ablation Strategies for Persistent AFPrior common procedures for persistent AF ablation include creation of linear lesions in the left atrium (LA) and focal ablation targeting complex fractionated electrograms (CFAEs Since the landmark study of Haïssaguerre et al demonstrating that the triggers initiating atrial fibrillation (AF) originate from the pulmonary veins (PVs), catheter ablation targeting PV has become an established strategy for paroxysmal AF. 1 The recognition that AF trigger sites were located within the PV antrum in the majority of cases led to extended, circumferential PV antrum isolation (PVAI) as an ablation procedure for AF. The recurrence of atrial tachyarrhythmias was reported to be significantly less in patients with large isolation areas around both ipsilateral PVs than in those with segmental PV isolation. 2 A recent study showed that, in patients with paroxysmal AF undergoing extended PVAI, the rate of late recurrence was lower than that previously reported with segmental or less extensive antral isolation. 3 Today, PVAI is the cornerstone of catheter-based therapies for paroxysmal AF. However, the success rates of catheter ablation in cases of persistent AF are significantly lower than those for paroxysmal AF. Progressive atrial remodeling in persistent AF has been regarded as a reason for the low efficacy of the treatment in persistent AF. Therefore, additional ablation strategies for modifying and eliminating the AF-sustaining atrial substrate have been developed and challenged.Recently, there has been technological progress in both 3D mapping systems and ablation catheters, which enable us to create precise high-resolution mapping and a durable Pulmonary vein (PV) antrum isolation (PVAI) is effective in treating paroxysmal atrial fibrillation (AF) but is less so for persistent AF. A recent randomized study on the ablation strategies for persistent AF demonstrated that 2 common atrial substrate modifications, creation of linear lesions in the left atrium and ablation of complex fractionated electrogram sites, in addition to PVAI did not improve the outcome compared with stand-alone PVAI, suggesting the necessity of a more individualized, selective approach to persistent AF. There are emerging technologies, including high-resolution mapping with the use of multi-electrode catheter and auto mapping system and contact force (CF) guide ablation; the former allows rapid and accurate confirmation of the completeness of PVAI, and the latter enhances the achievement of durable ablation lesions more securely. Ablation for fibrotic area(s) has been proposed as a new approach for substrate modification, and high-resolution mapping is useful to define the area ...

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Section: Endpoint Of Pvimentioning

confidence: 88%

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―

Okamatsu

Okumura

2018

Circ J

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“…3-5 Contact force (CF) monitoring of the ablation catheter might help achieve more durable lesions and substantially improve procedural outcomes. 6 A recent randomized, multicenter study, however, showed that CF data availability was associated with reduced acute PV reconnections but not improved 1-year success rates, procedure and fluoroscopy times, or complication rates. 7 The failure of CF monitoring to improve clinical outcome of AF ablation might be due to a lack of information on the catheter stability as well as the precise location of ablated lesions, and subsequent heterogeneous ablation intensity.…”

Section: Subjectsmentioning

confidence: 98%

Automated Ablation Annotation Algorithm Reduces Re-conduction of Isolated Pulmonary Vein and Improves Outcome After Catheter Ablation for Atrial Fibrillation

Tanaka

Inoue

Toyoshima

et al. 2017

Circ J

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VISITAG Module) uses an algorithm for the automated annotation of RF ablation applications based on objective, predefined parameters. Because it provides crucial information on catheter stability and ablation intensity at each site, it may be helpful in accomplishing durable PVI.The aim of this study was therefore to evaluate the utility of automated ablation lesion annotation by comparing procedure parameters and outcomes between automated annotation-guided and non-guided procedures. Methods SubjectsThe study was conducted under a retrospective, singlecenter observational design. We included 91 AF patients who underwent initial PVI by an experienced operator between June 2013 and January 2015. We performed 51 initial AF ablations from June 2014 to January 2015. We C atheter ablation (CA) is an effective therapy of atrial fibrillation (AF). The cornerstone of CA for AF is pulmonary vein isolation (PVI). 1,2 Despite initially successful PVI, however, recurrence of AF after CA occurs frequently and is often related to the recovery of conduction between the pulmonary vein (PV) and left atrium (LA). 3-5 Contact force (CF) monitoring of the ablation catheter might help achieve more durable lesions and substantially improve procedural outcomes. 6 A recent randomized, multicenter study, however, showed that CF data availability was associated with reduced acute PV reconnections but not improved 1-year success rates, procedure and fluoroscopy times, or complication rates. 7 The failure of CF monitoring to improve clinical outcome of AF ablation might be due to a lack of information on the catheter stability as well as the precise location of ablated lesions, and subsequent heterogeneous ablation intensity. Background: Durable pulmonary vein isolation (PVI) is critical in reducing recurrence after radiofrequency catheter ablation for atrial fibrillation (AF). The VISITAG Module, an automatic annotation system that takes account of catheter stability and contact force (CF), might be useful in accomplishing this.

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“…These studies have shown that some operators are able to estimate CF with a high degree of accuracy when CF information is not available and may explain why, when the CF information was available, none of these studies demonstrated a statistically significant improvement in long-term outcomes. [16][17][18] Despite the lack of superiority demonstrated by randomised studies, some experts consider their personal experience with CF catheters to be so favourable they would "consider it almost unethical to perform an AF RF ablation with a non-CF-sensing catheter". 19 It is possible that the failure to demonstrate unequivocal benefit can be explained by study design, variability in the catheter and mapping systems used and the absence of target guidelines at the procedural outset.…”

Section: Clinical Impact Of Contact Force Technologiesmentioning

confidence: 99%

Increasing the Single-Procedure Success Rate of Pulmonary Vein Isolation

Duytschaever

O’Neill

Martinek

2017

Arrhythmia &Amp; Electrophysiology Review

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To improve the single-procedural success and long-term outcomes of catheter ablation techniques for AF, there is a need for durable, contiguous and transmural lesions encircling the pulmonary veins (PV). Measurement of contact force (CF) between the catheter tip and the target tissue can optimise ablation procedures. A new approach to obtain single-procedure durable PV isolation (PVI) using the latest CF technology combined with the CARTO VISITAG ™ Module with Ablation Index (Biosense Webster) has been shown in small studies to almost eliminate recurrence of paroxysmal AF at 1-year follow up and to make PVI procedures more reproducible. The use of a standardised workflow is expected to increase the reproducibility of results and to increase the efficiency of PVI procedures. KeywordsCatheter ablation, contact force, pulmonary vein isolation, CARTO VISITAG™ Module, ablation index Disclosure: Mark O'Neill has received research support, honoraria and consulting fees from Biosense Webster; and research support, honoraria and consulting fees from Abbott/St Jude. Mattias Duytschaever has received honoraria for presentation and consulting from Biosense Webster. Acknowledgement:The authors are grateful to the technical editing support provided by Katrina Mountfort of Medical Media Communications (Scientific) Ltd, which was funded by Biosense Webster. Received A R R H Y T H M I A & E L E C T R O P H Y S I O L O G Y R E V I E W 218 Diagnostic Electrophysiology and Ablation Clinical Impact of Contact Force TechnologiesOptimising Outcomes in Pulmonary Vein Isolation What About Randomised Trials?The importance of optimal contact has been demonstrated in the prospective randomised non-inferiority Ablation Catheter Study for Atrial Fibrillation (TOCCASTAR) study, which compared the TactiCath catheter with a non-CF-sensing catheter (NAVISTAR ® ThermoCool ® ;Biosense Webster) in 300 patients undergoing catheter ablation of PAF. 14 When the CF arm was stratified into optimal CF (≥90 % ablations with ≥10 g) and non-optimal CF groups, effectiveness was achieved in 75.9 % versus 58.1 %, respectively (p=0.018).In a recent randomised trial performed at seven UK centres, 117 patients undergoing first-time PAF ablation were randomised to ablation with (CF-on) or without (CF-off) CF data available to the operator. A reduction in acute PV reconnection rates was seen in the CF-on group (22 % versus 32 %, p=0.03) but there was no significant difference in 1-year success rates (49 % versus 52 %, p=0.9). Furthermore, there was no difference in major complication rates, procedural times and fluoroscopy times. The investigators concluded that CF data availability as used in this study was associated with improved catheter control but did not impact on the clinical outcome. This confirms that CF is only one of multiple factors that determine lesion efficacy and safety. 15Three other small prospective randomised studies have compared CF versus non-CF-sensing catheter ablation. These studies have shown that some operators are able to est...

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Comparison of lesion formation between contact force-guided and non-guided circumferential pulmonary vein isolation: A prospective, randomized study

Cited by 118 publications

References 12 publications

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―

Automated Ablation Annotation Algorithm Reduces Re-conduction of Isolated Pulmonary Vein and Improves Outcome After Catheter Ablation for Atrial Fibrillation

Increasing the Single-Procedure Success Rate of Pulmonary Vein Isolation

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Comparison of lesion formation between contact force-guided and non-guided circumferential pulmonary vein isolation: A prospective, randomized study

Cited by 118 publications

References 12 publications

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation ― Impact of Progress in the Mapping and Ablation Technologies ―

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation ― Impact of Progress in the Mapping and Ablation Technologies ―

Automated Ablation Annotation Algorithm Reduces Re-conduction of Isolated Pulmonary Vein and Improves Outcome After Catheter Ablation for Atrial Fibrillation

Increasing the Single-Procedure Success Rate of Pulmonary Vein Isolation

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Resources

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Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―

Strategy and Outcome of Catheter Ablation for Persistent Atrial Fibrillation　― Impact of Progress in the Mapping and Ablation Technologies ―