Contact Force in Atrial Fibrillation: Role of Atrial Rhythm and Ventricular Contractions

Sarkozy, Andrea; Shah, Dipen; Saenen, Johan; Sieira, Juan; Phlips, Thomas; Boris, Wim; Namdar, Mehdi; Vrints, Christiaan J.

doi:10.1161/circep.115.003041

Cited by 29 publications

(35 citation statements)

References 12 publications

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“…4,5 Emerging studies in patients with AF, supraventricular tachycardia, and ventricular arrhythmia have suggested that measuring CF during catheter ablation may reduce procedure time and risk of complications and enable more effective lesion creation. 6,9,[11][12][13][14][15] The multicenter Toccata study evaluated the real-time measurement of CF during RFCA of supraventricular tachycardia and AF 8,16 and found that high CFs may occur even during catheter manipulation. 8 In agreement with a recent meta-analysis of CFguided AF ablation, 10 our study suggests that CF-guided RFCA of PVCs is as safe and effective as non-CF-guided ablation.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies in patients with AF showed that ablation with the CF-sensing catheter improved lesion size and depth and thus improved outcomes. 9,10 However, few studies have investigated the safety and effectiveness of the CF-sensing catheter when used for ablation of premature ventricular contractions (PVCs). 9,11 Therefore, we evaluated whether an irrigated CF-sensing catheter would improve the safety and effectiveness of RFCA of idiopathic PVCs originating from the right ventricular outflow tract (RVOT).…”

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confidence: 99%

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Benefit of Contact Force–Guided Catheter Ablation for Treating Premature Ventricular Contractions

Zhao¹,

Liu²,

Gao³

et al. 2020

Texas Heart Institute Journal

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We evaluated whether an irrigated contact force–sensing catheter would improve the safety and effectiveness of radiofrequency ablation of premature ventricular contractions originating from the right ventricular outflow tract. We retrospectively reviewed the charts of patients with symptomatic premature ventricular contractions who underwent ablation with a contact force–sensing catheter (56 patients, SmartTouch) or conventional catheter (59 patients, ThermoCool) at our hospital from August 2013 through December 2015. During a mean follow-up of 16 ± 5 months, 3 patients in the conventional group had recurrences, compared with none in the contact force group. Complications occurred only in the conventional group (one steam pop; 2 ablations suspended because of significantly increasing impedance). In the contact force group, the median contact force during ablation was 10 g (interquartile range, 7–14 g). Times for overall procedure (36.9 ± 5 min), fluoroscopy (86.3 ± 22.7 s), and ablation (60.3 ± 21.4 s) were significantly shorter in the contact force group than in the conventional group (46.2 ± 6.2 min, 107.7 ± 30 s, and 88.7 ± 32.3 s, respectively; P <0.001). In the contact force group, cases with a force-time integral <560 gram-seconds (g-s) had significantly longer procedure and fluoroscopy times (both P <0.001) than did those with a force-time integral ≥560 g-s. These findings suggest that ablation of premature ventricular contractions originating from the right ventricular outflow tract with an irrigated contact force–sensing catheter instead of a conventional catheter shortens overall procedure, fluoroscopy, and ablation times without increasing risk of recurrence or complications.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Benefit of Contact Force–Guided Catheter Ablation for Treating Premature Ventricular Contractions

Zhao¹,

Liu²,

Gao³

et al. 2020

Texas Heart Institute Journal

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“…Despite this evidence, in clinical practice, it is difficult to maintain sufficient average contact force and reduce contact‐force variability reliably . The adjustments made by an operator are limited by human factors (perception and reaction time) and system delays (including time required to average and display a mean force level), making it impossible to compensate for force variability in real‐time and highlighting the clear need for new technology to control catheter‐tissue contact force and optimize catheter ablation techniques.…”

Section: Introductionmentioning

confidence: 99%

Eliminating the effects of motion during radiofrequency lesion delivery using a novel contact‐force controller

Gelman

Skanes

Jones

et al. 2019

Cardiovasc electrophysiol

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Introduction Catheter‐tissue contact force is a determinant of radiofrequency (RF) ablation lesion effectiveness. However, ablation on a beating heart is subject to force variability, making it difficult to optimally deliver consistently durable and transmural lesions. This work evaluates improvements in contact force stability and lesion reproducibility by using a catheter contact‐force controller (CFC) during lesion delivery in vitro and in vivo. Methods and Results Using a sheath and force‐sensing catheter, an experienced operator attempted to maintain a constant force of 20 g at targets within the atria and left ventricle of a pig manually and using the CFC; the average force and contact‐force variation (CFV) achieved using each approach were compared. Ablation lesions (20 W, 30 seconds, 17 mL/min irrigation) were created in bovine tissue samples mounted on a platform programmed to reproduce clinically relevant motion. CFC‐assisted lesions were delivered to stationary and moving tissue with forces of 5 to 35 g. Mimicking manual intervention, lesions were also delivered to moving tissue while the CFC was disabled. Resultant lesion volumes were compared using two‐way analysis of variance. When using the CFC, the average force was within 1 g of the set level, with a CFV less than 5 g, during both in vitro and in vivo experiments. Reproducible and statistically identical (P = .82) lesion volumes proportional to the set force were achieved in both stationary and moving tissue when the CFC was used. Conclusions CFC assistance maintains constant force in vivo and removes effect of motion on lesion volume during RF lesion delivery.

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“…This is concerning as, between the left atrial and the esophageal wall, the small esophageal arteries can easily be caught in friendly fire as well, more so because the distances and force sensing would be very variable during atrial systole and diastole. 15 What have we learned from this current study? Perhaps foremost, this study highlights the limitations of contemporary 3D mapping and anatomic visualization.…”

Section: Editorial Commentmentioning

confidence: 95%

Friendly Fire During RF: Be Firm But Gentle!

Chakrabarti

Deyell

2016

Cardiovasc electrophysiol

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activation mapping of arrhythmias, atrial fibrillation/atrial arrhythmias, cardiac mapping -3-dimensional systems, catheter ablation -atrial fibrillation Editorial CommentThe contact between the target tissue and the ablation electrode is the major determinant of lesion size and transmurality of ablation lesions.1 Contact force guided ablation offers us the promise of predictable transmural lesions and hence it is currently one of the hottest topics in electrophysiology practice.The adoption of force-sensing technology has been very rapid and there is an honest optimism of about it being a giant step forward for ablation outcomes. The last such major advance was the introduction of irrigated catheters. Although most of the clinical development of this technology has been for atrial fibrillation ablation, the exciting scope of contact force sensing is allowing much wider field of application and acceptance in ablation of other substrates. 2-5However, whether force sensing technology is capable of producing a paradigm shift in atrial fibrillation ablation will need to be assessed critically in the future, although the trends suggest that it will. 6,7 While the ablationist is happy that RF energy applications are now going to be more effective, we need to be cognizant that with the precise firepower of these ablation catheters comes more caution. There are data to suggest that using 5-10 g of force is optimum for creating chamber geometry comparable to CT but at least 10 g of force, preferably 20 g, is required during energy applications to achieve durable RF lesions. 8,9 As an optimum force time interval (400-500 gramseconds) is being considered as a good surrogate for lesion quality, one can imagine the effect of having a reasonably high force within limits (<40-50 g) to reduce energy application time at a particular target.1 However, force being a continuous variable, incremental application of the same in a soft tissue chamber like the heart or vessels will initially result in progressive stretching of the chamber wall with potential wall disruption, even without energy application. The catheterinduced chamber wall tenting has the potential of bringing the tip of the ablation electrode in closer proximity to adjacent anatomical structures and their collateral but unfortunate involvement during radiofrequency energy application.

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Contact Force in Atrial Fibrillation: Role of Atrial Rhythm and Ventricular Contractions

Cited by 29 publications

References 12 publications

Benefit of Contact Force–Guided Catheter Ablation for Treating Premature Ventricular Contractions

Benefit of Contact Force–Guided Catheter Ablation for Treating Premature Ventricular Contractions

Eliminating the effects of motion during radiofrequency lesion delivery using a novel contact‐force controller

Friendly Fire During RF: Be Firm But Gentle!

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