The impact of steerable sheaths on unblinded contact force during catheter ablation for atrial fibrillation
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The purpose of this study was to evaluate the impact of steerable sheaths on multiple contact force parameters during atrial fibrillation (AF) ablation. Steerable sheaths are commonly used during AF ablation, at an additional cost to standard fixed-curve sheaths. However, there is little data on their incremental value in the era of contact force-guided radiofrequency ablation.
This multi-center cohort study included consecutive patients undergoing index pulmonary vein (PV) isolation with a force-sensing catheter. Operators employed either only steerable or only fixed-curve sheaths. Operators targeted a force of 10–40 g for each ablation lesion. Automated ablation lesion assessment software with standardized settings was employed.
Of 85 subjects, 52 and 33 underwent ablation with steerable and fixed-curve sheaths, respectively. The steerable sheath group showed significantly higher average and maximum forces, but predominantly for the right PVs. The proportion of lesions with ≥ 10% of time with less than 10 g of force was lower in the steerable sheath group (adjusted odds ratio 0.56, steerable vs. fixed; 95% confidence interval 0.35, 0.89, p = 0.01). Improved stability was seen in the posterior aspect of both PV pairs. The proportion of RF time-in-target (the proportion of RF time meeting lesion criteria) was not different between the two groups (p = 0.176).
Even with contemporary contact force targets, steerable sheath use in AF ablation is associated with better average and maximum contact force and increased stability in comparison to fixed-curve sheaths.
KeywordsAtrial fibrillation Catheter ablation Contact force Steerable sheath
This study was supported through funding from the Division of Cardiology, University of British Columbia. Drs. Deyell, Laksman, and Andrade are recipients of Career Investigator Awards from the Michael Smith Foundation for Health Research (British Columbia, Canada).
We would like to thank Colin Magor, Product Specialist, Biosense-Webster Canada, for his technical support with extraction of the contact force data.
Dr. Deyell was responsible for the study design and concept, data analysis, and interpretation and drafting of the manuscript. Dr. Wen was responsible for the study design, data analysis, and revision of the manuscript. Drs. Bennett, Chakrabarti, Yeung-Lai-Wah, and Krahn were responsible for the study concept and critical revision of the manuscript. Dr. Andrade was responsible for the study design, data interpretation, and critical revision of the manuscript. All authors approved the final version.
Compliance with ethical standards
Conflict of interest
Dr. Deyell has received research funding and honoraria from Biosense-Webster. Dr. Laksman has received research funding from Abbott Medical. Dr. Andrade has received research funding from Medtronic and Baylis Medical.
Ethics approval and informed consent
This study was approved by the human ethics institutional review board at our institutions. Waiver of consent was granted for this study on the basis of minimal risk. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.
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