Impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation

Q: What are the key findings of this study?

Perpendicular catheter contact during pulmonary vein isolation was associated with a significantly higher rate of pulmonary vein reconnection (OR 3.26) compared to non-perpendicular contact.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=27). Intervention: Perpendicular catheter contact (>60°) vs. Non-perpendicular catheter contact. Primary outcome: Pulmonary vein reconnection (gap area) (OR 3.26, 95% CI 1.71-6.22, p=<0.001).

Q: What does this research mean for the field?

Perpendicular catheter contact during pulmonary vein isolation results in smaller lesions and is associated with a significantly higher rate of pulmonary vein reconnection compared to non-perpendicular contact. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate how catheter contact angle affects radiofrequency lesion geometry and the long-term durability of pulmonary vein isolation.

Masayuki Ohta; Kentaro Hayashi; Hiroyuki Sato; T Noto; Kandoh Kawahatsu; Masaya Katagiri; Tomohiro Mita; Yoshio Kazuno; Shunsuke Sasaki; Takahiro Doi; Mitsugu Hirokami; Satoshi Yuda

doi:10.1007/s10840-022-01131-1

January 26, 2022Journal of Interventional Cardiac ElectrophysiologyOpen Access

Impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation

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Key result

Perpendicular catheter contact during PVI is linked to ~226% higher pulmonary vein reconnection risk.

OR 3.26
95% CI 1.71-6.22
P<0.001
n=27

Figures

Why the study?

The study was conducted to evaluate the impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation.

Does perpendicular catheter contact angle increase the risk of pulmonary vein reconnection in patients undergoing catheter ablation for atrial fibrillation?

Key Points

To evaluate how catheter contact angle affects radiofrequency lesion geometry and the long-term durability of pulmonary vein isolation.
Assessed radiofrequency lesion dimensions across three contact angles (0°, 45°, and 90°) in an in vitro model using explanted swine hearts.
Retrospectively analyzed 666 ablation tags from 16 patients undergoing repeat catheter ablation for recurrent atrial fibrillation to characterize pulmonary vein reconnection gaps.
In vitro lesion width was smallest with perpendicular (90°) contact (5.3 ± 0.4 mm) compared to 0° (5.8 ± 0.5 mm, p = 0.040) and 45° (6.4 ± 0.4 mm, p < 0.001).
Multivariate analysis identified perpendicular contact (OR 3.26, p < 0.001), longer interlesion distance (OR 1.49, p < 0.001), and greater contact force variability (OR 1.03, p = 0.008) as independent predictors of pulmonary vein reconnection gaps.

Study Design

Type

Observational (n=27)

Multicenter

No

Structured PICO

Does perpendicular catheter contact angle increase the risk of pulmonary vein reconnection in patients undergoing catheter ablation for atrial fibrillation?

P

Population

27 consecutive patients (mean age 60.7, 81.5% male) who underwent repeat catheter ablation due to atrial fibrillation recurrence after initial pulmonary vein isolation, and an in vitro swine heart model.

I

Intervention

Perpendicular catheter contact angle (>60°) during radiofrequency ablation.

C

Comparator

Non-perpendicular catheter contact angle (0° or 45°).

O

Outcome

Pulmonary vein reconnection (gap area) in repeat ablation and lesion width/depth in vitro.surrogate

Main Result

Effect estimate: OR 3.26 (95% CI 1.71-6.22)

Absolute Event Rate: 23% vs 5.6%

p-value: p=<0.001

Perpendicular catheter contact during pulmonary vein isolation is associated with smaller lesion size and a higher risk of pulmonary vein reconnection.

Limitations

In vitro study conducted under limited setting of contact force, ablation time, and power
Retrospective study conducted in a single center
Small sample size
Most of the study population were men (81.5%)
Operator's habit to apply the catheter might have an effect on the gap area
In vitro study conducted under limited setting of CF, ablation time, and power
Superficial lesion width was not measured
Retrospective study was conducted in a single-center and had a small sample size
Operator's habit to apply the catheter might have effect on the gap area

Implication

Perpendicular contact may raise PV reconnection risk during PVI; leaves open optimal angle confirmation in prospective trials.

Abstract

PURPOSE: This study is aimed to evaluate the impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation (PVI). METHODS: Both in vitro experiment and retrospective observational study were conducted. For in vitro experiment, radiofrequency lesions were created on explanted swine hearts in three different catheter contact angles (0°, 45°, and 90°). In the retrospective observational study, we assessed patients who had undergone repeat catheter ablation due to atrial fibrillation recurrence after initial PVI. When pulmonary vein (PV) reconnection was observed, we analyzed the previous ablation points within and without the gap area. The gap areas were where ablation had changed the PV activation sequence or eliminated the PV potential in the repeat session. RESULTS: In the in vitro experiment, lesion width was the smallest (5.3 ± 0.4 mm) in perpendicular contact compared to 0° (vs 5.8 ± 0.5 mm, p = 0.040) and 45° (vs 6.4 ± 0.4 mm, p < 0.001). In the retrospective observational study, we assessed 666 tags of 16 patients with PV reconnections, and 60 tags were in the gap area. Tags in the gap area had longer interlesion distance (odds ratio [OR] 1.49, p < 0.001), greater contact force variability (OR 1.03, p = 0.008), and higher rate of perpendicular contact (OR 3.26, p < 0.001) on multivariate analysis. CONCLUSIONS: Perpendicular contact was associated with a smaller lesion and higher rate of PV reconnection.

Discussion

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Cite This Study

Ohta et al. (2022) conducted an observational in Atrial fibrillation (n=27). Perpendicular catheter contact (>60°) vs. Non-perpendicular catheter contact was evaluated on Pulmonary vein reconnection (gap area) (OR 3.26, 95% CI 1.71-6.22, p=<0.001). Perpendicular catheter contact during pulmonary vein isolation was associated with a significantly higher rate of pulmonary vein reconnection (OR 3.26) compared to non-perpendicular contact.

synapsesocial.com/papers/6a12e74d45487b7639a75d08 https://doi.org/10.1007/s10840-022-01131-1

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Impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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