Contact force sensing technology identifies sites of inadequate contact and reduces acute pulmonary vein reconnection: A prospective case control study

Haldar, Shouvik; Jarman, Julian W.E.; Panikker, Sandeep; Jones, David G.; Salukhe, Tushar V.; Gupta, Dhiraj; Wynn, Gareth J.; Hussain, Wajid; Markides, Vias; Wong, Tom

doi:10.1016/j.ijcard.2012.11.072

Cited by 100 publications

(78 citation statements)

References 24 publications

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“…675,676,677 These low CF sites have correlated with sites of PV reconnection. 677 CFS catheters provide operator feedback to allow for more homogeneous force delivery and reduce impedance rise, cardiac perforation, steam pops, and thrombus formation while at the same time improving effective lesion formation. 453,668,671,676,678,679,680 …”

Section: Section 6: Technology and Toolsmentioning

confidence: 92%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,754

1,468

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Section: Section 6: Technology and Toolsmentioning

confidence: 92%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

1,754

1,468

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“…A mean segment CF during ablation of ≥19.6g was less frequently observed to be associated with acute reconnection, 15 and at 3-month follow up, segments within a wide area circumferential ablation ablated with a minimum FTI <400 g·s had a greater chance of being reconnected. 16 These previous studies subdivided the ipsilateral pulmonary vein ablation lines into 7 15 or 8 16 segments and judged the adequacy of the multiple ablations in these segments based on whether the whole segment reconnected. The current study differs in approach as we investigated at the level of the individual lesion, using biophysical and electrogram parameters, rather than against the wider segment outcome.…”

Section: Discussionmentioning

confidence: 85%

Target Indices for Clinical Ablation in Atrial Fibrillation

Ullah

Hunter

Baker

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-In animal studies of radiofrequency ablation, lesion sizes plateau as the maximum lesion size is reached for an ablation. Lesion parameters are not available in clinical ablations, but preclinical work suggests that these correlate with impedance drop and electrogram attenuation. Characterization of the relationships between catheter contact force, ablation duration, and these surrogate markers of lesion formation may allow us to define targets for effective ablation. Methods and Results-Fifteen patients undergoing first-time radiofrequency ablation for nonparoxysmal atrial fibrillation were studied. All were in atrial fibrillation at the time of the procedure. Ablations were performed with an irrigated-tip contact force-sensing catheter in temperature-controlled mode (temperature limited to 48°C, power to 30 W). Included were 285 left atrial static ablations, 247 with additional impedance data. The ablation force time integral (FTI) correlated with the attenuation of the electrogram with ablation (Spearman ρ, -0.14; P=0.02): the relationship plateauing from 500 g·s, a reduction in the electrogram amplitude of 20%. The FTI also correlated with the impedance drop during ablation (Spearman ρ, 0.79; P<0.0005): the relationship was logarithmic, the reduction in the impedance with an increasing FTI also plateauing from 500 g·s, an impedance drop of 7.5%. The ablation duration affected the impedance drop at an FTI if the duration was <10 s. Beyond this time point, the FTI achieved rather than the ablation duration or mean contact force applied determined the impedance drop. Conclusions-During nonparoxysmal atrial fibrillation ablation, an FTI of 500 g·s should be targeted with ablation duration of ≥10 s. Clinical Trials Registration-URL: http://clinicaltrials.gov/. Unique Identifier: NCT01587404.(Circ Arrhythm Electrophysiol. 2014;7:63-68.)

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“…Significant reductions in procedure, fluoroscopy, radiofrequency ablation times, and acute PV reconnection rates were observed. [4][5][6][7][8] A significant reduction of AF recurrence rate at 12 months of follow-up was also reported with the use of CF-sensing catheters. 7,8 Intermittent contact (reaching 0 g at every diastole) was evaluated in 2 previous clinical studies.…”

mentioning

confidence: 67%

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

Sarkozy¹,

Shah²,

Saenen³

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background-In an experimental model, variable and intermittent contact force (CF) resulted in a significant decrease in lesion volume. In humans, variability of CF during pulmonary vein isolation has not been characterized. Methods and Results-In 20 consecutive patients undergoing CF-guided circumferential pulmonary vein isolation, 914 radiofrequency applications (530 in sinus rhythm and 384 in atrial fibrillation) were analyzed. The variability of the 60% CF range (CF 60% ) was 17±9.6 g. Hundred seventy-one (19%) applications were delivered with constant, 717 (78%) with variable, and 26 (3%) with intermittent CF. The mean CF and force-time integral were significantly higher during applications with variable than with intermittent or constant CF. There was no significant difference in CF variability, CF 60% variability, and force-time integral between applications delivered in sinus rhythm and atrial fibrillation. The main reasons for CF variability were systolo-diastolic heart movement (29%) and respiration (27%). In 10 additional patients, during adenosine-induced atrioventricular block, the minimum CF significantly increased at 19 sites (5.3±4.4 versus 13.4±5.9 g; P<0.001) and at 16 sites intermittent or variable CF became constant. At only 1 site systolo-diastolic movement remained the main reason for variable CF. Conclusions-CF during pulmonary vein isolation remains highly variable despite efforts to optimize contact. CF and CF parameters were similar during sinus rhythm and atrial fibrillation. The main reasons for CF variability are systolodiastolic heart movement and respiration. The systolo-diastolic peaks and nadirs of CF are because of ventricular contractions at the large majority of pulmonary vein isolation sites. (Circ Arrhythm Electrophysiol. 2015;8:1342-1350.

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Contact force sensing technology identifies sites of inadequate contact and reduces acute pulmonary vein reconnection: A prospective case control study

Cited by 100 publications

References 24 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Target Indices for Clinical Ablation in Atrial Fibrillation

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

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