Reduced residual conduction gaps and favourable outcome in contact force-guided circumferential pulmonary vein isolation

Abstract

AimsAlthough contact force (CF)-guided circumferential pulmonary vein isolation (CPVI) for paroxysmal atrial fibrillation (PAF) is useful, AF recurrence at long-term follow-up still remains to be resolved. The purpose of this study was to assess safety and efficacy of CF-guided CPVI and to compare residual conduction gaps during CPVI and long-term outcome between the conventional (non-CF-guided) and the CF-guided CPVI.Methods and resultsWe studied the 50 consecutive PAF patients undergoing CPVI by a ThermoCool EZ Steer catheter (conventional group, mean age 61 ± 10 years) and the other 50 consecutive PAF patients by a ThermoCool SmartTouch catheter (CF group, 65 ± 11 years). The procedure parameters and residual conduction gaps during CPVI, and long-term outcome for 12 months were compared between the two groups. Circumferential pulmonary vein isolation was successfully accomplished without any major complications in both groups. Total procedure and total fluoroscopy times were both significantly shorter in the CF group than in the conventional group (160 ± 30 vs. 245 ± 61 min, P < 0.001, and 17 ± 8 vs. 54 ± 27 min, P < 0.001, respectively). Total number of residual conduction gaps was significantly less in the CF group than in the conventional group (2.7 ± 1.7 vs. 6.3 ± 2.7, P < 0.05). The AF recurrence-free rates after CPVI during 12-month follow-up were 96% (48/50) in the CF group and 82% (41/50) in the conventional group (P = 0.02 by log rank test). Multivariate Cox regression analysis further supported this finding.ConclusionContact force-guided CPVI is safe and more effective in reducing not only the procedure time but also the AF recurrence than the conventional CPVI, possibly due to reduced residual conduction gaps during CPVI procedure.

Comparison of the efficacy between impedance‐guided and contact force‐guided atrial fibrillation ablation using an automated annotation system

“…Contact force sensing catheters have allowed continuous monitoring of the CF during catheter ablation procedures. Previous studies demonstrated that the lesion size correlated well with the CF, and PV isolation with a CF sensing catheter reduced any residual conduction gaps and the incidence of PV reconnections . The present study showed that PV isolation with CF monitoring had a higher success rate of PV isolation after creating an initial circumferential ablation line.…”

Role of contact force‐guided radiofrequency catheter ablation for treatment of atrial fibrillation: A systematic review and meta‐analysis

“…Optimal tissue contact during the procedure was conceptually associated with a maximal ablation efficacy, while minimized the incidence of perforation and steam pops . Since the advent of CF‐sensing technology, a majority of clinical studies had identified the beneficial effect of RF ablation implemented with CF measurement in improving primary effectiveness and safe outcomes . Data from other contemporary studies, however, provided conflicting results .…”

Radiofrequency catheter ablation of atrial fibrillation: Electrical modification suggesting transmurality is faster achieved with remote magnetic catheter in comparison with contact force use

“…The procedural success of radiofrequency (RF) paroxysmal atrial fibrillation (AF) ablation is associated with complete and perennial pulmonary veins (PVs) isolation by adjacent transmural lesion creation. After AF ablation, PV reconnections are mainly the fact of non‐transmural lesion creating gaps of conduction in the lines, responsible for clinical recurrences . Transmurality obtention is multifactorial, and may be predicted by electrograms (EGMs) modification …”

“…After AF ablation, PV reconnections are mainly the fact of nontransmural lesion creating gaps of conduction in the lines, responsible for clinical recurrences. 1 Transmurality obtention is multifactorial, and may be predicted by electrograms (EGMs) modification. 2 There is now overwhelming proof that electrode-tissue contact force (CF) during RF application is a major determinant of RF lesions size.…”