Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Idiopathic outflow tract ventricular arrhythmias (OT-VAs) (n=102). Intervention: Contact force-sensing (CFS) open-irrigated catheter ablation vs. Standard open-irrigated catheter ablation without contact force-sensing. Primary outcome: Long-term ablation success (over 80% reduction of arrhythmia burden after at least 3 months in repeated 24-h ECG monitoring during a minimum 12-month follow-up) (p=0.357).

Q: What does this research mean for the field?

Contact force-sensing catheters provide no significant advantage over standard catheters in acute or long-term procedural success or safety during non-fluoroscopic radiofrequency catheter ablation of outflow tract ventricular arrhythmias. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Grzegorz Karkowski; Marcin Kuniewicz; Andrzej Ząbek; Edward Koźluk; Maciej Dębski; Paweł T. Matusik; Jacek Lelakowski

doi:10.3390/jcm11030593

January 25, 2022Journal of Clinical MedicineOpen Access

Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias

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Key result

Contact force-sensing catheters show no long-term success benefit over standard catheters for outflow tract VA ablation.

P=0.357
n=102

Figures

Why the study?

Adequate catheter-tissue contact is important for optimal lesion formation, but the potential benefits of contact force-sensing catheters during non-fluoroscopic RFCA of outflow tract ventricular arrhythmias needed evaluation.

Does the use of contact force-sensing catheters improve acute and long-term procedural success or safety compared to standard irrigated catheters in patients undergoing non-fluoroscopic radiofrequency catheter ablation for idiopathic outflow tract ventricular arrhythmias?

Key Points

To evaluate whether contact force-sensing catheters improve procedural effectiveness and safety compared with standard catheters during non-fluoroscopic radiofrequency catheter ablation of idiopathic outflow tract ventricular arrhythmias.
Retrospective analysis of 102 consecutive patients undergoing non-fluoroscopic radiofrequency catheter ablation (CARTO system) of outflow tract ventricular arrhythmias between 2014 and 2018.
Patients were treated using either contact force-sensing catheters (n = 52) or standard non-sensing catheters (n = 50), with arrhythmias originating in the right outflow tract (n = 70) or left outflow tract (n = 32).
Follow-up lasted a minimum of 12 months (overall mean 51.3 ± 21.6 months; median 40.0 months for contact force-sensing vs 69.5 months for standard catheters, p < 0.001).
Overall acute procedural success was 96.1% (n = 98), with no significant difference between the contact force-sensing (96.2%) and standard catheter groups (96.0%, p > 0.99).
Long-term success occurred in 85.3% (n = 87) overall, remaining similar between contact force-sensing (88.5%) and standard catheter cohorts (82.0%, p = 0.357).
Major complication rates did not differ significantly between groups (n = 2 pericarditis in the contact force group vs n = 1 pseudoaneurysm in the standard group, p > 0.99), whereas median procedural duration was significantly longer with contact force catheters (90.0 vs 80.0 min, p = 0.029).

Study Design

Type

Cohort (n=102)

Structured PICO

Does the use of contact force-sensing catheters improve acute and long-term procedural success or safety compared to standard irrigated catheters in patients undergoing non-fluoroscopic radiofrequency catheter ablation for idiopathic outflow tract ventricular arrhythmias?

P

Population

102 patients (mean age 43.4 years, 61.8% female) with symptomatic idiopathic outflow tract ventricular arrhythmias undergoing non-fluoroscopic radiofrequency catheter ablation, followed for a mean of 51.3 months.

E

Exposure

Non-fluoroscopic radiofrequency catheter ablation (NF-RFCA) guided by CARTO electroanatomic mapping using 3.5 mm open irrigated-tip contact force-sensing (CFS) catheters (Thermocool SmartTouch, n=52), with a target contact force of 10-30 g (power 30-40 W in RVOT, 20-30 W in LVOT, irrigation 15-30 mL/min, application time 60 s, max temp 45 °C).

C

Comparator

Non-fluoroscopic radiofrequency catheter ablation (NF-RFCA) guided by CARTO electroanatomic mapping using standard 3.5 mm open irrigated-tip catheters without contact force-sensing (Navistar Thermocool, n=50) with identical RF power, irrigation, duration, and temperature settings.

O

Outcome

Long-term ablation efficacy, defined as a >80% reduction of arrhythmia burden on repeated 24-hour Holter ECG monitoring (performed at 3 months and every 6-12 months thereafter) during a minimum 12-month follow-up (mean 51.3 ± 21.6 months).hard clinical

Main Result

Absolute Event Rate: 88.5% vs 82%

p-value: p=0.357

Limitations

Relatively small patient group, especially those with LVOT PVCs origin
Retrospective study design without randomization
Catheter choice was based on the individual operator's decision
Unequal distribution of CFS vs. standard catheters across different study years and significantly shorter follow-up in the CFS group
No information on actual contact force achieved during applications, only the targeted value
Relatively small sample size, particularly for LVOT arrhythmia origin
Retrospective, non-randomized study design
Operator-dependent selection of catheter type introducing potential selection bias
Temporal imbalance in catheter usage (CFS used more frequently from 2016 onward) resulting in significantly shorter follow-up in the CFS group
Lack of recorded actual contact force values achieved during RF applications

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Implication

No added benefit from contact force-sensing catheters; leaves open their role in non-fluoroscopic outflow tract VA ablation.

Abstract

Background: Adequate contact between the catheter tip and tissue is important for optimal lesion formation and, in some procedures, it has been associated with improved effectiveness and safety. We evaluated the potential benefits of contact force-sensing (CFS) catheters during non-fluoroscopic radiofrequency catheter ablation (NF-RFCA) of idiopathic ventricular arrhythmias (VAs) originating from outflow tracts (OTs). Methods: A group of 102 patients who underwent NF-RFCA (CARTO, Biosense Webster Inc., Irvine, CA, USA) of VAs from OTs between 2014 to 2018 was retrospectively analyzed. Results: We included 52 (50.9%) patients in whom NF-RFCA was performed using CFS catheters and 50 (49.1%) who were ablated using standard catheters. Arrhythmias were localized in the right and left OT in 70 (68.6%) and 32 (31.4%) patients, respectively. The RFCA acute success rate was 96.1% (n = 98) and long-term success during a minimum 12-month follow-up (mean 51.3 ± 21.6 months) was 85.3% (n = 87), with no difference between CFS and standard catheters. There was no difference in complications rate between CFS (n = 1) and standard catheter (n = 2) ablations. Conclusions: There is no additional advantage of CFS catheters use over standard catheters during NF-RFCA of OT-VAs in terms of procedural effectiveness and safety.

Discussion

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Cite This Study

Karkowski et al. (2022) conducted a cohort in Idiopathic outflow tract ventricular arrhythmias (OT-VAs) (n=102). Contact force-sensing (CFS) open-irrigated catheter ablation vs. Standard open-irrigated catheter ablation without contact force-sensing was evaluated on Long-term ablation success (over 80% reduction of arrhythmia burden after at least 3 months in repeated 24-h ECG monitoring during a minimum 12-month follow-up) (p=0.357). Contact force-sensing catheters showed no significant difference in long-term success compared to standard catheters (88.5% vs. 82.0%, p=0.357) during non-fluoroscopic ablation of outflow tract VAs.

synapsesocial.com/papers/6a7f1a66eddee3b6110d23e4 https://doi.org/10.3390/jcm11030593

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Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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