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Contact force facilitates the achievement of an unexcitable ablation line during pulmonary vein isolation

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Abstract

Aims

Contact force (CF) catheters provide catheter-tissue contact information to improve outcome of pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). We evaluated different target-CF values for achievement of the additional endpoint of an unexcitable ablation line.

Methods

A total of 106 patients undergoing PVI were randomized into three groups (G) (G1: target-CF 15 g, G2: target-CF 10 g, G3: CF concealed from operator). The PVI encircling line was divided into predefined sections. Excitable tissue along the PVI-line identified by high output pacing (10 V, 2 ms) was targeted for further ablation.

Results

Mean average CF was 17.4 ± 4.7 g (G1) vs. 12.3 ± 6.0 g (G2) vs. 11.1 ± 6.5 g (G 3) (p < 0.001). Primary unexcitable ablation lines were found in 38.6, 19.4 and 5.7% (G1, G2, G3 respectively; G1 vs. G2 p < 0.05, G1 vs. G3 p < 0.001, G2 vs. G3 ns). Additional radiofrequency (RF)-energy to achieve unexcitability was lowest in G1 (3.6 ± 3.1 kJ vs. 8.6 ± 7.2 kJ (G2) and 10.4 ± 6.7 (G3), p ≤ 0.001, G2 vs. G3 ns) with accordingly lowest additional RF applications in G1 (3.0 ± 2.6 vs. 7.0 ± 5.4 in G2 and 8.4 ± 4.0 in G3; G1 vs. G2 and G3, p < 0.001, G 2 vs. G 3 ns). Sections along ablation lines with low initial CF were most likely to reveal excitability. Single procedure success was 81.9 vs. 73.5 vs. 71.4% (G 1, 2 and 3, p = 0.6) during 437 ± 254 day follow-up.

Conclusion

Higher tip-to-tissue CF during PVI facilitates the achievement of an unexcitable ablation line, requiring less additional RF-energy.

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Authors and Affiliations

  1. Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center, Martinistr. 52, 20246, Hamburg, Germany

    Benjamin Schaeffer, Stephan Willems, Christian Meyer, Ruken Ö. Akbulak, Julia Moser, Mario Jularic, Christian Eickholt, Jana M. Schwarzl, Melanie Gunawardene & Pawel Kuklik

  2. Department of Cardiology-Electrophysiology, University Hospital Cologne, Cologne, Germany

    Jakob Lüker, Arian Sultan & Daniel Steven

  3. Department of Cardiology-Electrophysiology, University Hospital Mainz, Mainz, Germany

    Boris A. Hoffmann

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  1. Benjamin Schaeffer
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  2. Stephan Willems
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  3. Christian Meyer
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Correspondence to Benjamin Schaeffer.

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Schaeffer, B., Willems, S., Meyer, C. et al. Contact force facilitates the achievement of an unexcitable ablation line during pulmonary vein isolation. Clin Res Cardiol 107, 632–641 (2018). https://doi.org/10.1007/s00392-018-1228-0

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  • DOI: https://doi.org/10.1007/s00392-018-1228-0

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