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Impact of real-time contact force and impedance measurement in pulmonary vein isolation procedures for treatment of atrial fibrillation

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

Use of CF catheters in PVI has a beneficial effect on procedural parameters, probably by improving efficacy of transmural lesion formation.

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Acknowledgments

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

None.

Ethical statement

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.

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Authors and Affiliations

  1. Department of Medicine I, Klinikum Grosshadern, University of Munich and Munich Heart Alliance, Marchionistraße 15, 81377, Munich, Germany

    Reza Wakili, Sebastian Clauss, Viola Schmidt, Anton Hahnefeld, Franziska Schüssler, Johannes Siebermair, Stefan Kääb & Heidi L. Estner

  2. Heart Center Siegburg, Siegburg, Germany

    Michael Ulbrich

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  1. Reza Wakili
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  2. Sebastian Clauss
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Correspondence to Reza Wakili.

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Reza Wakili and Sebastian Clauss contributed equally to this work.

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Wakili, R., Clauss, S., Schmidt, V. et al. Impact of real-time contact force and impedance measurement in pulmonary vein isolation procedures for treatment of atrial fibrillation. Clin Res Cardiol 103, 97–106 (2014). https://doi.org/10.1007/s00392-013-0625-7

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  • DOI: https://doi.org/10.1007/s00392-013-0625-7

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