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Contact-force radiofrequency ablation of non-paroxysmal atrial fibrillation: improved outcomes with increased experience

  • Chirag R. BarbhaiyaEmail author
  • Robert J. Knotts
  • Katy Bockstall
  • Scott Bernstein
  • David Park
  • Douglas Holmes
  • Anthony Aizer
  • Larry A. Chinitz
MULTIMEDIA REPORT

Abstract

Introduction

Clinical trials have failed to reliably show improved outcomes with utilization of contact-force sensing (CFS) radiofrequency (RF) ablation catheters. It is unknown whether the unfavorable outcomes observed in these trials are attributable to inexperience with CFS technology.

Objectives

To compare catheter ablation outcomes of stepwise linear ablation with versus without CFS technology and to assess the impact of operator experience with CFS technology on procedural outcomes.

Methods

Clinical outcomes were evaluated in 228 consecutive NPAF patients undergoing first-time left atrial ablation using a stepwise linear approach. Arrhythmia recurrence was assessed using 2-week event monitors at 3-month intervals following index ablation.

Results

A total of 228 patients were included in our study. There was no statistically significant difference in risk of recurrent atrial arrhythmias at 12 and 24 months between CFS and non-CFS patients (p = 0.5 and p = 0.169). The time to recurrence of atrial arrhythmias at 24 months in the second half of CFS patients was significantly lower when compared to both the first half of CFS patients (p = 0.002) and non-CFS patients (p = 0.005).

Conclusion

While there was no difference in overall outcomes between CFS and non-CFS ablation using a stepwise linear approach in patients with NPAF, procedural efficacy of the second half of CFS patients was significantly improved compared to both the first half of CFS patients and all non-CFS patients. Lack of benefit seen in clinical trials using CFS technology may be related to operator inexperience with CFS ablation catheters at the time of the trials.

Keywords

Atrial fibrillation Catheter ablation Contact-force sensing Radiofrequency ablation Stepwise Procedural outcomes 

Notes

Funding information

Relationships to industry are all modest and less than $10,000. Dr. Barbhaiya has received speaking fees/honoraria from Abbott, Inc., Biotronik, Inc., Medtronic, Inc., and Zoll, Inc., and received research support from Biotronik, Inc. Dr. Holmes has research support from Abbott. Dr. Aizer has served as a consultant for Biosense Webster, Inc., received research support from Abbott Inc., and Sentreheart, Inc., and received fellowship support from Abbott, Inc., Biotronik, Inc., Boston Scientific, Inc., and Medtronic, Inc. Dr. Chinitz has received speaking fees/honoraria from Abbott, Medtronic, Biotronik, Biosense and Fellowship/Research from Medtronic, Biotronik, and Biosense.

Supplementary material

10840_2019_618_MOESM1_ESM.docx (45 kb)
ESM 1 (DOCX 45 kb)
10840_2019_618_MOESM2_ESM.docx (49 kb)
ESM 2 (DOCX 49 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Leon H. Charney Division of Cardiology, New York University Langone HealthNew York University School of MedicineNew YorkUSA

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