Impact of real-time contact force and impedance measurement in pulmonary vein isolation procedures for treatment of atrial fibrillation
- 611 Downloads
Pulmonary vein isolation (PVI) is an established procedure to treat atrial fibrillation (AF). New techniques are necessary to improve procedural parameters like shortening of procedure duration. Real-time contact force (CF) catheters are new tools aiming to improve PVI by optimizing electrode–tissue contact and generating more effective lesions. Objective of this study was to investigate the influence on procedural parameters and clinical outcome by using a CF catheter for PVI.
PVI was performed on 67 consecutive patients using a CF catheter (n = 32) or a standard ablation catheter (SAC, n = 35). Study endpoints included number of energy applications, impedance drop, fluoroscopy time, and left atrial (LA) procedure time and freedom from AF after 6 and 12 months.
Procedural endpoint was reached in all patients with a similar clinical outcome (freedom from AF) in both groups 6 months (62.9 vs. 62.5 %) and 12 months post PVI (59.4 vs. 62.9 % in CF vs. SAC group, respectively). However, CF-guided ablation resulted in a greater fall of impedance (6.58 ± 0.33 vs. 9.09 ± 0.53 Ω, *** p < 0.001), lower number of energy applications (44.20 ± 3.67 vs. 34.06 ± 3.11, * p < 0.05), reduction of LA procedure time (95.52 ± 7.35 vs. 78.08 ± 7.23* min) and a significant reduction of fluoroscopy time (51.4 ± 3.3 vs. 33.0 ± 2.7*** min). In addition, a detailed analysis showed a significant correlation between quantitative impedance drop and amount of CF applied, suggesting more efficient lesion creation by CF-guided ablation.
Use of CF catheters in PVI has a beneficial effect on procedural parameters, probably by improving efficacy of transmural lesion formation.
KeywordsArrhythmia Atrial fibrillation Ablation Pulmonary vein isolation Contact force catheter Impedance
The authors thank Bianca Hildebrandt and Thomas Matis for their help with data acquisition and processing. This study contains elements of the doctoral thesis of Viola Schmidt. Funding: Fondation Leducq European-North American Atrial Fibrillation Research Alliance (ENAFRA, 07/CVD/03, S.K.), “Förderprogramm für Forschung und Lehre der LMU” (FöFoLe), University of Munich, Germany (R.W.); NGFN Plus (S.K.), LMU Excellence Initiative (S.K.), Spitzencluster m4 “Personalisierte Medizin” (S.K.) and German Centre for Cardiovascular Research (S.K.).
Conflict of interest
The study was approved by the local ethics committee and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent prior to their inclusion in the study.
- 3.Lampe B, Hammerstingl C, Schwab JO et al (2012) Adverse effects of permanent atrial fibrillation on heart failure in patients with preserved left ventricular function and chronic right apical pacing for complete heart block. Clin Res Cardiol 101(10):829–836. doi: 10.1007/s00392-012-0468-7 PubMedCrossRefGoogle Scholar
- 10.Vollmann D, Sossalla S, Schroeter MR, Zabel M (2013) Renal artery ablation instead of pulmonary vein ablation in a hypertensive patient with symptomatic, drug-resistant, persistent atrial fibrillation. Clin Res Cardiol 102(4):315–318. doi: 10.1007/s00392-012-0529-y PubMedCentralPubMedCrossRefGoogle Scholar
- 13.Calkins H, Kuck KH, Cappato R et al (2012) 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. Heart Rhythm 9(4):632–696.e621. doi: 10.1016/j.hrthm.2011.12.016 PubMedCrossRefGoogle Scholar
- 19.Richter B, Gwechenberger M, Socas A et al (2012) Markers of oxidative stress after ablation of atrial fibrillation are associated with inflammation, delivered radiofrequency energy and early recurrence of atrial fibrillation. Clin Res Cardiol 101(3):217–225. doi: 10.1007/s00392-011-0383-3 PubMedCrossRefGoogle Scholar
- 21.Yokoyama K, Nakagawa H, Shah DC et al (2008) Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circulation Arrhythmia and electrophysiology 1(5):354–362. doi: 10.1161/CIRCEP.108.803650 PubMedCrossRefGoogle Scholar
- 22.Kautzner J, Neuzil P, Peichl P, et al (2012) Contact force, force time integral and lesion continuity are critical to improve durable PV isolation: EFFICAS 2 results. Heart Rhythm 9(5S):1–564Google Scholar
- 25.Neuzil P, Kautzner J, Cihak R, et al (2011) EFFICAS I early results: does gap formation following pulmonary vein isolation correlate with low contact force? Europace 13 (Suppl 3): NP. doi: 10.1093/europace/eur214 (Abstract)
- 30.Hoffmann E, Remp T, Gerth A et al (1993) Preablation 50 kHz impedance: a new parameter for assessing myocardial wall contact before radiofrequency catheter ablation. J Am Coll Cardiol 21:49AGoogle Scholar
- 31.Reithmann C, Remp T, Hoffmann E, Matis T, Wakili R, Steinbeck G (2005) Different patterns of the fall of impedance as the result of heating during ostial pulmonary vein ablation: implications for power titration. Pacing Clin Electrophysiol 28(12):1282–1291. doi: 10.1111/j.1540-8159.2005.00269.x PubMedCrossRefGoogle Scholar
- 35.Haldar S, Jarman JW, Panikker S, et al (2012) Contact force sensing technology identifies sites of inadequate contact and reduces acute pulmonary vein reconnection: A prospective case control study. Int J Cardiol. doi: 10.1016/j.ijcard.2012.11.072
- 36.Shah DC, Lambert H, Nakagawa H, Langenkamp A, Aeby N, Leo G (2010) Area under the real-time contact force curve (force–time integral) predicts radiofrequency lesion size in an in vitro contractile model. J Cardiovasc Electrophysiol 21(9):1038–1043. doi: 10.1111/j.1540-8167.2010.01750.x PubMedCrossRefGoogle Scholar