Contact force and force-time integral in atrial radiofrequency ablation predict transmurality of lesions

Squara, Fabien; Laţcu, Decebal Gabriel; Massaad, Youssef; Mahjoub, M.; Bun, Sok‐Sithikun; Saoudi, Nadir

doi:10.1093/europace/euu068

Cited by 110 publications

(83 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is possible that contact forcesensing catheters may lead to an improvement in outcomes. These catheters have already shown to be effective in improving lesion formation 35 and the outcomes of paroxysmal AF ablation. 36 Another explanation is that recurrence occurs because of progression of atrial disease, with development of further fibrosis and arrhythmogenic triggers leading to arrhythmia relapse requiring further ablation.…”

Section: Why Is Cfae Ablation Of No Benefit?mentioning

confidence: 99%

Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Providência

Lambiase

Srinivasan

et al. 2015

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Background-Ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as a strategy to improve outcomes in atrial fibrillation (AF) catheter ablation, but the use of this technique remains contentious. We aimed to assess the impact of CFAE ablation in addition to pulmonary vein isolation (PVI) in patients undergoing ablation for AF. Methods and Results-We performed a random effects meta-analysis of studies comparing PVI versus PVI+CFAE ablation.The outcomes of freedom from AF/atrial tachycardia after 1 or several ablation procedures and acute procedural-related complications were assessed. Studies were searched on MEDLINE, EMBASE, COCHRANE, and clinicaltrials.gov, and sensitivity analyses were performed. Thirteen studies including a total of 1415 patients were considered eligible.

show abstract

Section: Why Is Cfae Ablation Of No Benefit?mentioning

confidence: 99%

Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Providência

Lambiase

Srinivasan

et al. 2015

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…Hence, an FTI Z400 g/s has been suggested as a surrogate end-point to predict the creation of transmural lesions in RF. 5,6 Booth et al recently highlighted the new real-time CF parameter of lesion size index (LSI). This novel parameter incorporates RF power, ablation duration, and CF in a dimensionless ratio independent of traditional parameters.…”

Section: Introductionmentioning

confidence: 99%

Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Boles

Gül

Fitzpatrick

et al. 2017

JICRM

View full text Add to dashboard Cite

ABSTRACT. The application of optimum contact force (CF) can be used to improve ablation procedure success and safety. The lesion size index (LSI) is a novel dimensionless contact force parameter that allows for an accurate estimation of lesion volume in real time by integrating contact force (grams), duration (seconds) and power (watts). The aim was to correlate LSI values with current contact force parameters to achieve successful and safe bidirectional block of the cavotricuspid isthmus (CTI) using a maximum voltage-guided (MVG) ablation strategy. Fifteen consecutive patients (age 69±7.9 years, nine males) with symptomatic atrial flutter (AFL) were evaluated and compared with 23 control (age 66.3 ± 10.4 years, 16 males) non-contact forceguided ablation cases. Irrigated-tip force-sensing ablation catheters (TactiCath Quartzt, St. Jude Medical, St. Paul, MN, USA) were used in the CF group to achieve the primary endpoint of complete bidirectional block of the isthmus. In the CF group, a total of 233 radiofrequency (RF) applications were examined. A mean LSI of 6.4 ± 1.0 correlated with a force-time integral (FTI) of 581.2±230.9 g/s and an average CF of 13.9±4.9 g concurrently. Intraprocedural, fluoroscopy time and RF time demonstrated lower trends in the CF group, but no significance with respect to these trends was observed. The secondary endpoint of no reconnection within 20 min after the procedure was equally attained in both groups, and, likewise, the level of safety was comparable. An LSI value of 45 represents a new effective parameter in MVG ablation for the cavotricuspid region that demonstrates a safe profile. Guidance of CTI ablation using LSI and other contact force parameters of CF 13.9 ± 4.9 g and FTI 581.2 ± 230.9 g/s demonstrated highly effective and safe outcomes.

show abstract

“…Yet the dynamic range represents additional information on stability and the spectrum of forces that are applied during any given lesion to achieve the 400 g/s FTI target. 6,7 There is limited information on dynamic range; recently Kumar et al 10 showed a critical association between ventilation and ablation effectiveness; the index for dynamic ranges of force were noted to be strongly affected by respiration phase. This dynamic catheter behavior has implications for tip electrode stability, intermittent contact, and effectiveness of RF lesions.…”

Section: Discussionmentioning

confidence: 99%

“…An FTI Z400 g/s was previously suggested as an end point for effective lesions when contiguous lesion formation was possible. 6,7 We hypothesized that the dynamic range of forces may affect attempts to achieve 400 g/s and may be influenced by anatomic location and left atrial size, as this is a measure of stability of tissue contact. Higher peak forces have the potential for complication in addition to variable effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Dynamic Ranges of Contact Force During Radiofrequency Ablation

Boles¹,

Enríquez²,

Riegert³

et al. 2016

JICRM

View full text Add to dashboard Cite

ABSTRACT. The aim was to assess the dynamic range for contact force (CF df ) in order to achieve an effective lesion according to anatomic variables under conscious sedation. We retrospectively studied 674 radiofrequency (RF) lesions (21 procedures) at Kingston General Hospital. Consecutive patients employing a CF catheter were recruited. A force-sensing catheter was used to continuously record CF data and force-time integral (FTI) during each lesion. The CF df represents the difference between the highest and lowest recorded contact force for each RF application. Out of 674 lesions examined, we included 438 (65%). The CF df was significantly greater in the left atrium than in the right (36.6±20.3 versus 28.7±16.4, po0.01). Except in the cavotricuspid isthmus, the FTI lesions equal or are more than 400 g/s required higher CF df in all anatomical locations, and these differences reached statistical difference on the right atrial free wall, left atrial posterior wall, and right pulmonary vein antrum (p ¼ 0.011, 0.007, and o0.001). Yet, higher CF df is an independent predictor for less successful lesions in stepwise regression model. Left atrial enlargement above 46 mm was associated with lower CF df , CF av , and CF max (p ¼ 0.04, o0.001, and 0.02 respectively). This study represents the first detailed assessment of CF df in conscious sedation patients. Significant variations in the CF df were associated with different anatomic locations. We found that the greater the dynamic range the less likely the lesion would reach 400 g/s. Smaller atria were associated with higher dynamic ranges and greater peak and average forces.KEYWORDS. Average contact force, dynamic range for contact force, force time integral, maximum contact force, radiofrequency ablation.

show abstract

Contact force and force-time integral in atrial radiofrequency ablation predict transmurality of lesions

Abstract: Contact force and FTI during RF are correlated with TL. During RF delivery, a target FTI > 392 gs can be used as an endpoint.

Cited by 110 publications

References 17 publications

Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Is There Still a Role for Complex Fractionated Atrial Electrogram Ablation in Addition to Pulmonary Vein Isolation in Patients With Paroxysmal and Persistent Atrial Fibrillation?

Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Dynamic Ranges of Contact Force During Radiofrequency Ablation

Contact Info

Product

Resources

About