Catheter-tissue contact force values do not impact mid-term clinical outcome following pulmonary vein isolation in patients with paroxysmal atrial fibrillation
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Catheter-tissue contact is critical for effective lesion creation in radiofrequency catheter ablation (RFCA). In a multicenter prospective study, we assessed the relationship between catheter contact force (CF) during RFCA for paroxysmal atrial fibrillation (AF) and clinical recurrences over a mid-term follow-up.
All patients underwent RFCA for paroxysmal AF by antral pulmonary vein (PV) isolation, aiming at entry and exit conduction block in all PVs. A new open-irrigated tip catheter with CF sensing (SmartTouchTM, Biosense Webster Inc. CA) was used. All patients were followed for at least 12 months and the relationship between CF and clinical outcomes assessed.
One year follow-up was available in 92/95 of the patients enrolled. Acute PV isolation was achieved in 100 % of the veins. Mean CF during RFCA was 12.2 ± 3.9 g. Mean force-time integral (FTI) was 733 ± 505 gs. Following the 3-month blanking period, 17 (18 %) patients experienced at least 1 atrial tachyarrhythmia relapse. There was no statistical difference in mean CF (13 ± 3.4 g vs 12 ± 4 g, p = 0.32) and mean FTI (713 ± 487 gs vs 822 ± 590 gs, p = 0.42) between patients with and without arrhythmia recurrences. Recurrences were recorded in 22 % of patients achieving a mean FTI value below the median of 544 gs and in 15 % of patients with a mean FTI value above the median (p = 0.64).
RFCA with CF data during PV isolation for paroxysmal AF improves physician’s knowledge on catheter-tissue contact. In the present dataset, however, higher CF values did not impact mid-term clinical RFCA outcome.
KeywordsCatheter ablation Atrial fibrillation Contact force
Conflict of interest
Dr. Roberto De Ponti is a consultant of Biosense Webster and Dr. Emanuele Bertaglia is a consultant of Biosense Webster, St. Jude Medical and Boston Scientific. There is no conflict of interest for the other authors.
- 2.Avitall B, Mughal K, Hare J, Helms R, Krum D. The effects of electrode-tissue contact on radiofrequency lesion generation. Pace Clin Electrophysiol. 1997;20[Pt. 11:2899–910).Google Scholar
- 3.Thiagalingam, A., D’Avila, A., Floley, L., Guerrero, J. L., Lambert, H., Leo, G., Ruskin, J. N., & Reddy, V. Y. (2010). Importance of catheter contact force during irrigated radiofrequency ablation: evaluation in a porcine ex vivo model using a force-sensing catheter. Journal of Cardiovascular Electrophysiology, 21, 806–811.PubMedGoogle Scholar
- 4.Olson, M. D., Phreaner, N., Schuller, J. L., Nguyen, D. T., Katz, D. F., Aleong, R. G., Tzou, W. S., Sung, R., Varosy, P. D., & Sauer, W. H. (2013). Effect of catheter movement and contact during application of radiofrequency energy on ablation lesion characteristics. Journal of Interventional Cardiac Electrophysiology, 38, 123–129.CrossRefPubMedGoogle Scholar
- 5.Waldo, A. L., Wilber, D. J., Marchlinski, F. E., Stevenson, W. G., Aker, B., Ming Boo, L., & Jackman, W. M. (2012). Safety of the open-irrigated catheter for radiofrequency ablation: safety analysis from six clinical studies. Pacing and Clinical Electrophysiology, 35, 1081–1089.CrossRefPubMedGoogle Scholar
- 6.Scaglione, M., Blandino, A., Raimondo, C., Caponi, D., Di Donna, P., Toso, E., Ebrille, E., Cesarani, F., Ferrarese, E., & Gaita, F. (2012). Impact of ablation catheter irrigation design on silent cerebral embolism after radiofrequency catheter ablation of atrial fibrillation: results from a pilot study. Journal of Cardiovascular Electrophysiology, 23, 801–805.CrossRefPubMedGoogle Scholar
- 7.Bertaglia, E., Fassini, G., Anselmino, M., Stabile, G., Grandinetti, G., De Simone, A., Calò, L., Pandozi, C., Pratola, C., Zoppo, F., Tondo, C., Iuliano, A., & Gaita, F. (2013). Comparison of ThermoCool(®) Surround Flow Catheter Versus ThermoCool(®) catheter in achieving persistent electrical isolation of pulmonary veins: a pilot study. Journal of Cardiovascular Electrophysiology, 24, 269–273.CrossRefPubMedGoogle Scholar
- 8.Stabile, G., Bertaglia, E., Pappone, A., Themistoclakis, S., Tondo, C., Calzolari, V., Bottoni, N., Arena, G., Rebellato, L., Del Greco, M., De Simone, A., Corò, L., Avella, A., Anselmino, M., & Pappone, C. (2014). Low incidence of permanent complications during catheter ablation for atrial fibrillation using open irrigated catheters: a multicenter registry. Europace, 16, 1154–1159.CrossRefPubMedGoogle Scholar
- 9.Martinek, M., Lemes, C., Sigmund, E., Derdorfer, M., Aichinger, J., Winter, S., Nesser, H. J., & Pürerfellner, H. (2012). Clinical impact of a new open-irrigated radiofrequency catheter with direct force measurement on atrial fibrillation ablation. Pacing and Clinical Electrophysiology, 35, 1312–1318.CrossRefPubMedGoogle Scholar
- 10.Stabile, G., Solimene, F., Calò, L., Anselmino, M., Castro, A., Pratola, C., Golia, P., Bottoni, N., Grandinetti, G., De Simone, A., De Ponti, R., Dottori, S., & Bertaglia, E. (2014). Catheter-tissue contact force for pulmonary veins isolation: a pilot multicentre study on effect on procedure and fluoroscopy time. Europace, 16, 335–340.CrossRefPubMedCentralPubMedGoogle Scholar
- 11.Marijon, E., Fazaa, S., Narayanan, K., Guy-Moyat, B., Bouzeman, A., Providencia, R., Treguer, F., Combes, N., Bortone, A., Boveda, S., Combes, S., & Albenque, J. P. (2013). Real-time contact force sensing for pulmonary vein isolation in the setting of paroxysmal atrial fibrillation: procedural and 1-year results. Journal of Cardiovascular Electrophysiology. doi: 10.1111/jce.12303.PubMedGoogle Scholar
- 12.Reddy, V. Y., Shah, D., Kautzner, J., Schmidt, B., Saoudi, N., Herrera, C., Jaïs, P., Hindricks, G., Peichl, P., Yulzari, A., Lambert, H., Neuzil, P., Natale, A., & Kuck, K. H. (2012). The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm, 9, 1789–1795.CrossRefPubMedGoogle Scholar
- 13.Stabile, G., Scaglione, M., Del Greco, M., De Ponti, R., Bongiorni, M. G., Zoppo, F., Soldati, E., Marazzi, R., Marini, M., Gaita, F., Iuliano, A., & Bertaglia, E. (2012). Reduced fluoroscopy exposure during ablation of atrial fibrillation using a novel electroanatomical navigation system: a multicentre experience. Europace, 14, 60–65.CrossRefPubMedGoogle Scholar
- 14.Bertaglia, E., Stabile, G., Senatore, G., Zoppo, F., Turco, P., Amellone, C., De Simone, A., Fazzari, M., & Pascotto, P. (2005). Predictive value of early atrial fibrillation recurrence after circumferential pulmonary vein ablation. Pacing and Clinical Electrophysiology, 28, 366–371.CrossRefPubMedGoogle Scholar
- 15.Haldar, S., Jarman, J. W., Panikker, S., Jones, D. G., Salukhe, T., Gupta, D., Wynn, G., Hussain, W., Markides, V., & Wong, T. (2013). Contact force sensing technology identifies sites of inadequate contact and reduces acute pulmonary vein reconnection: a prospective case control study. International Journal of Cardiology, 168, 1160–1166.CrossRefPubMedGoogle Scholar
- 16.Neuzil, P., Reddy, V. Y., Kautzner, J., Petru, J., Wichterle, D., Shah, D., Lambert, H., Yulzari, A., Wissner, E., & Kuck, K. H. (2013). Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circulation. Arrhythmia and Electrophysiology, 6, 327–333.CrossRefPubMedGoogle Scholar
- 17.Park, C. L., Lehrmann, H., Keyl, C., Weber, R., Schiebeling, J., Allgeier, J., Schurr, P., Shah, A., Neumann, F. J., Arentz, T., & Jadidi, A. S. (2014). Mechanisms of pulmonary vein reconnection after radiofrequency ablation of atrial fibrillation: the deterministic role of contact force and interlesion distance. Journal of Cardiovascular Electrophysiology, 25, 701–708.CrossRefPubMedGoogle Scholar