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Clinical utility of automated ablation lesion tagging based on catheter stability information (VisiTag Module of the CARTO 3 System) with contact force-time integral during pulmonary vein isolation for atrial fibrillation

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Abstract

Background

The clinical utility of an automated lesion tagging module based on catheter stability information (VisiTag) with the CARTO system during atrial fibrillation (AF) ablation remains to be established. We investigated whether VisiTag-guided extensive encircling pulmonary vein isolation (EEPVI) produces durable lesions.

Methods

The study involved 54 patients undergoing EEPVI for paroxysmal AF. We performed EEPVI guided by the module-generated ablation tags, i.e., “VisiTags,” which are point-by-point ablation tags placed on 3D maps. The patients were divided into two groups: those treated under a moderate catheter stability VisiTag setting, i.e., a 3-mm distance limit for at least 5 s and a minimum contact force (CF) of 8 g over 25 % of the set time period with a target force-time integral (FTI) ≥300 g*s (n = 27), and those treated under a strict catheter stability setting, i.e., a 3-mm distance limit for at least 10 s and a minimum CF of 10 g over 50 % of the set time period with a target FTI ≥400 g*s (n = 27).

Results

After EEPVI, adenosine triphosphate-provoked dormant PV conduction was observed in six (22 %) patients in the moderate catheter stability group and in one (4 %) patient in the strict catheter stability group (p = 0.1003); the 12.9-month success rate was 81 % in both groups.

Conclusions

The strict catheter stability setting for automated lesion tagging together with a target FTI of >400 g*s, vs. the moderate catheter stability setting with a target FTI of >300 g*s, produces less frequent ATP-provoked PV conduction and yields a comparably high mid-term success rate.

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Acknowledgments

The authors thank Ms. Wendy Alexander-Adams and Mr. George Powell for their encouragement and assistance with the reporting of our findings in English.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Nihon University School of Medicine, 30-1 Ohyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan

    Yasuo Okumura, Ichiro Watanabe, Kazuki Iso, Koichi Nagashima, Kazumasa Sonoda, Naoko Sasaki, Rikitake Kogawa, Keiko Takahashi, Kimie Ohkubo, Toshiko Nakai & Atsushi Hirayama

  2. Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan

    Shiro Nakahara & Yuuichi Hori

Authors
  1. Yasuo Okumura
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  2. Ichiro Watanabe
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  3. Kazuki Iso
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  4. Koichi Nagashima
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  5. Kazumasa Sonoda
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  6. Naoko Sasaki
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  9. Kimie Ohkubo
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  10. Toshiko Nakai
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  11. Shiro Nakahara
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  12. Yuuichi Hori
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  13. Atsushi Hirayama
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Corresponding author

Correspondence to Yasuo Okumura.

Ethics declarations

The study protocol was approved by our institutional review boards, and all patients provided written informed consent for their participation.

Conflict of interest

The authors declare that they have no conflict of interest.

Funding sources

The study was supported by departmental resources only.

Additional information

Results of a preliminary study that was conducted in preparation for the study described herein were presented at the Joint Meeting of the 30th Annual Meeting of the Japanese Heart Rhythm Society and the 32nd Annual Scientific Meeting of the Japanese Society of Electrocardiology that was held in July 2015.

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Okumura, Y., Watanabe, I., Iso, K. et al. Clinical utility of automated ablation lesion tagging based on catheter stability information (VisiTag Module of the CARTO 3 System) with contact force-time integral during pulmonary vein isolation for atrial fibrillation. J Interv Card Electrophysiol 47, 245–252 (2016). https://doi.org/10.1007/s10840-016-0156-z

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  • DOI: https://doi.org/10.1007/s10840-016-0156-z

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