Key result
Contact force sensing-guided ablation did not reduce total radiofrequency time compared to a CFS-blinded strategy in persistent AF (49 ± 14 vs 50 ± 20 min; P=0.70).
Why the study?
The impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) was unknown.
Does contact force sensing-guided catheter ablation reduce cumulative radiofrequency time and improve arrhythmia-free survival compared to a contact force-blinded strategy in patients undergoing first-time ablation for persistent atrial fibrillation?
RCT (n=128)
Single-blind (operators in the control arm were blinded to force data)
Randomized
Yes
Does contact force sensing-guided catheter ablation reduce cumulative radiofrequency time and improve arrhythmia-free survival compared to a contact force-blinded strategy in patients undergoing first-time ablation for persistent atrial fibrillation?
Visualizing real-time contact force data during persistent AF ablation did not reduce radiofrequency time or improve 12-month arrhythmia-free survival compared to a blinded strategy, although lower force and force-time integral were associated with lesion gaps.
Answers are grounded in this paper and cite their sources.
Routine real-time contact force feedback does not improve procedural efficiency or clinical outcomes in persistent AF; challenges assumed clinical benefits of force-guided ablation over standard techniques.
Background Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. Objective The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Methods Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. Results PeAF was continuous for 26 weeks (interquartile range [IQR] 13-52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6-20] and 14 g [IQR 9-20] (P = .10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P = .70). Single procedure freedom from atrial arrhythmia was 60% in the CFS-guided arm and 63% in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6-19] vs 13.2 g [IQR 8-20], respectively; P = .0007) and less force-time integral (174 gs [IQR 91-330] vs 210 gs [IQR 113-388], respectively; P <.001). Conclusion CFS-guided ablation resulted in no difference to RF time or 12-month outcome. Lower force/force-time integral was associated with significantly more gaps.
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Conti et al. (2017) conducted an RCT in Persistent atrial fibrillation (n=128). Contact force sensing (CFS)-guided catheter ablation (wide antral pulmonary vein isolation plus roof line) vs. CFS-blinded catheter ablation (force data hidden from operators) was evaluated on Cumulative radiofrequency (RF) time for all procedures (p=0.70). Contact force sensing-guided ablation did not reduce total radiofrequency time compared to a CFS-blinded strategy in persistent AF (49 ± 14 vs 50 ± 20 min; P=0.70).
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