Contact force monitoring during circumferential anatomic ablation for paroxysmal atrial fibrillation increased acute pulmonary vein isolation (80% vs 32%, P=0.001) and shortened procedure times.
RCT (n=50)
Single-blind
Randomized
Does contact force monitoring improve acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation undergoing circumferential anatomic ablation?
Contact force monitoring during circumferential anatomic ablation for paroxysmal AF significantly improves acute pulmonary vein isolation and reduces procedure and fluoroscopy times.
Absolute Event Rate: 80% vs 32%
p-value: p=0.001
BACKGROUND: The impact of contact force (CF) monitoring in pulmonary vein (PV) isolation after a circumferential anatomic ablation (CAA) is unknown. We analyze the usefulness of CF monitoring in acute PV isolation and procedure parameters using a CAA. METHODS: Fifty patients with paroxysmal atrial fibrillation were randomized into CF-on (CF >10 grams; n = 25) or CF-off (CF blinded; n = 25) groups. We performed a first round of CAA with a ThermoCool(®) SmartTouch(®) catheter blinded to the LASSO(®) catheter (Biosense Webster, Diamond Bar, CA, USA), with radiofrequency (RF) lesions tagged with the VisiTag(™) Module. After the CAA, each PV was reviewed with the LASSO(®) catheter recording the segments with gaps. RESULTS: All the PVs were isolated with a CAA in 20 patients of the CF-on versus eight of the CF-off (P = 0.001). Of the 45 segments with gaps in the left PVs, 38 were from the CF-off (P = 0.0001). Of the eight segments with gaps in the right PVs, seven were from the CF-off (P = 0.06). The CF in the left PVs was higher in the CF-on (16.3 ± 3.2 grams vs 10.5 ± 4.3 grams; P = 0.0001) and similar in the right PVs (17.6 ± 3.6 grams vs 15.2 ± 5.3 grams; P = 0.08). All of the gaps were closed with additional RF LASSO(®) -guided touch-up. Procedure and fluoroscopy times were shorter in the CF-on (139 ± 24 minutes vs 157 ± 32 minutes and 20 ± 6 minutes vs 24 ± 7 minutes; both P = 0.039). At 12 months the patients free of AF recurrence was 84% CF-on versus 75% CF-off (log-rank P = 0.4) corrected. CONCLUSIONS: In paroxysmal atrial fibrillation, a CAA guided by CF reduces PV gaps and shortens the procedure parameters at the expense of the left PVs.
Pedrote et al. (2016) conducted an RCT in Paroxysmal atrial fibrillation (n=50). Contact force (CF) monitoring (CF-on) vs. CF-off (CF blinded) was evaluated on Acute pulmonary vein isolation with a circumferential anatomic ablation (p=0.001). Contact force monitoring during circumferential anatomic ablation for paroxysmal atrial fibrillation increased acute pulmonary vein isolation (80% vs 32%, P=0.001) and shortened procedure times.
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