Similar outcomes with manual contact force ablation catheters and traditional catheters in the treatment of outflow tract premature ventricular complexes

Abstract

Aims Unlike in atrial fibrillation ablation, there is a lack of appropriately sized and properly designed studies regarding outflow tract (OT) premature ventricular complex (PVC) ablation outcomes with contact force sensing (CFS) catheters. We aimed to compare the acute success-, complication-, and long-term recurrence rates of manual CFS catheters with traditional irrigated catheters (T) in OT PVC ablation. Methods and results Single-centre, propensity-matched data of 75–75 patients ablated for right-sided OT (RVOT) or left-sided OT (LVOT) PVCs in 2015–17 with CFS or T catheters were compared. Acute success rate, peri-procedural complications, post-procedural daily PVC burden, and long-term recurrence rates were compared on intention-to-treat basis. Acute success rate equalled 80% in both groups, with no difference in force values in the CFS group comparing successful or failed cases [12.0 (8.75–17.0) vs. 16.0 (10.25–22.25) g, P = 0.21]. There were three cases of pseudo-aneurysm and one cardiac tamponade. PVC burden fell significantly from baseline 22 (15–30)% to 2 (0–10)% (P < 0.0001), with no difference between catheter types [CFS: 1 (0–7)% vs. T: 4 (1–12) %; P = 0.21]. There was no significant difference in recurrence-free survival of CFS and T catheters (58 vs. 59%, P = 0.29) during 12 months of follow-up, respectively. Recurrence in the CFS group did not differ either by the force exerted below or above the median value of 12 g (P = 0.66). Conclusion Both types of catheters can effectively reduce OT PVC burden with minimal serious complication rates. Ablation with CFS or T catheters gives similar acute- and long-term results.

Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias

“…The results of our study show no advantages of CFS over standard catheters in NF-RFCA of OT-VAs, in keeping with previous publications concerning the same arrhythmia type but performed with fluoroscopy guidance [14,15,18]. Reichlin et al [14] and Abraham et al [15] compared the effectiveness and safety of CFS vs. standard catheters and showed similar outcomes in LVOT and RVOT arrhythmia ablation. In other studies, the use of CFS catheters only shortened a procedural, fluoroscopy and ablation time [18].…”

“…Recent publications have demonstrated the safety and efficacy of NF-RFCA in OT arrhythmias, but the role of CFS catheters in this setting is unknown [1,4,5]. The results of our study show no advantages of CFS over standard catheters in NF-RFCA of OT-VAs, in keeping with previous publications concerning the same arrhythmia type but performed with fluoroscopy guidance [14,15,18]. Reichlin et al [14] and Abraham et al [15] compared the effectiveness and safety of CFS vs. standard catheters and showed similar outcomes in LVOT and RVOT arrhythmia ablation.…”

“…Additionally, in the TOCCATA study, cardiac perforation was linked to excessive CF based on blinded CFS measurements [19]. On the contrary, in previously published data and our study results, there is no evidence of the significant implication of the CFS catheter on safety during ventricular RFCA, independent of the presence of structural heart disease, arrhythmia localization, or fluoroscopy use [14,15,18,[24][25][26]. Novel techniques are introduced in cardiac electrophysiology [27].…”

“…Notably, the improved procedural outcomes were evident when >90% of applications were in the optimal range with a minimum of 10 g. For VA ablation there is lack of such strong data indicating a clear CF cut off needed for procedural outcome improvement. In a recent retrospective study by Abraham et al [15] (CFS catheters n = 75 vs. standard catheters n = 75), the median CF was 12.0 (9.5-18.5) g and did not differ significantly between acute success and failure. Larger studies regarding optimal CF in VAs ablation would be valuable.…”

“…Due to outflow tract anatomy and ventricular tissue thickness, especially in septal location, such as left ventricular (LV) summit, optimal CF is theoretically very desirable, especially in the NF procedure. However, published data are contradictory and recent studies revealed no advantage of CFS guidance in fluoroscopic RFCA compared to standard open irrigated catheters of OT-VAs [14,15]. Due to the increasing role of NF-RFCA, we aimed to evaluate the potential benefits of open irrigated CFS catheters in RFCA of idiopathic VAs from OTs without fluoroscopy guidance.…”