Choice of Steerable Sheath Impacts Contact Force Stability During Pulmonary Vein Isolation

Figures

• 

  Figure 1:. Analysis of CF parameters. Small inadvertent movements contribute to catheter instability and fluctuations in CF. Measurements obtained from the electroanatomic mapping system were used to assess mean CF and CF variability for each lesion. Poor contact was considered when CF dropped below 5 g; lesions with poor contact for more than 10% of the RF application time were defined as “inefficient contact lesions.” CF: contact force.

• 

  Figure 2:. Comparison of CF in the left versus right PVs. A: A higher mean CF per lesion was achieved among the right-sided PVs (ie, RIPV and RSPV) than among the left-sided PVs (ie, LIPV and LSPV). B: A higher level of CF variability was observed among individual lesions in the right-sided veins than in the left-sided veins. CF: contact force. *p = 0.001.

• 

  Figure 3:. Analysis of CF variability within individual ablation lesions. A: A significantly lower CF variability was found when using the SureFlex™ sheath than the Agilis™ sheath. B: Similar trends were observed in each of the PVs with a lower CF variability when using the SureFlex™ sheath; however, this did not reach statistical significance. *p = 0.043.

• 

  Figure 4:. Inefficient contact lesions with greater than 10% of the ablation time below the minimum acceptable CF (CF < 5 g). A: Fewer inefficient contact lesions were found in the SureFlex™ group than in the Agilis™ group. B: Difficult-to-access right-sided PVs (ie, RIPV and RSPV) had the greatest difference in inefficient contact lesions between the SureFlex™ and Agilis™ groups. CF: contact force. *p < 0.001; **p = 0.009.

• 

  Figure 5:. RF time per lesion. A: The RFA time to reach the acute lesion endpoint (ie, an impedance drop of approximately 10 Ω) was 12% shorter in the SureFlex™ group than in the Agilis™ group. B: The RF time per lesion was 9% to 21% lower in the LSPV, RIPV, and RSPV when using the SureFlex™ sheath. LI: left inferior; LS: left superior; RI: right inferior; RS: right superior. *p = 0.002; **p = 0.022; ***p = 0.003; ‡p = 0.048.