Abstract 13509: A Prospective Randomized Study on the Prevalence, Characteristics, and Predictors of Pulmonary Vein Reconnections and the Clinical Outcomes Between Contact Force-Guided and Conventional Circumferential Pulmonary Vein Isolation of Atrial Fibrillation

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Purpose: To prospectively investigate the differences in pulmonary vein reconnections (PVRs) and clinical outcomes between contact force (CF)-guided and conventional circumferential PV isolation (CPVI) of atrial fibrillation (AF). Methods: A total of 120 consecutive AF patients (63±10 years; 88 males) undergoing an initial CPVI were randomized to ablation with a target CF of 20g (CF-group; n=60) or that with operators blinded to the CF information (Blind-group; n=60). The right and left CPVI lines were each divided into 12 segments, and the occurrence of PVRs and CF-related parameters were evaluated in each segment. Time-dependent and adenosine-dependent PVRs were assessed twice during the procedure, just after completing the CPVI and at the end of the procedure. Results: The CF-group had significantly fewer PVRs (0.67±0.91/patient vs. 1.16±1.16/patient; P=0.007), a higher percentage of adenosine-dependent transient PVRs (60.5% vs. 28.8%; P=0.001), and lower percentage of persistent PVRs than the Blind-group. The mean CF was higher in the CF-group than in the Blind-group (Median, 18.0g vs. 16.1g; P<0.001), with the most significant difference observed along the posterior right-sided PVs (P-RPVs) and anterior left-sided PVs (A-LPVs). In multiple logistic regression models, the mean CF was a negative predictor of PVRs along the P-RPVs and A-LPVs in the Blind-group (odds ratios, 0.728 and 0.786; P<0.001 and 0.007), while no significant predictor was identified in the CF-group or along the anterior RPVs and posterior LPVs in the Blind-group. In the Kaplan-Meier analysis, the arrhythmia-free survival rate at 12 months was 91.2% in the CF-group (29.8% with antiarrhythmic drugs [AADs]) and 89.4% in the Blind-group (21.1% with AADs), respectively (P=0.596). Conclusions: CF-guided CPVI can reduce PVRs and result in a higher percentage of adenosine-dependent transient PVRs, and may be particularly beneficial along regions where a relatively low CF tends to be applied: the P-RPVs and A-LPVs. The comparable clinical outcomes may be due to (1) the learning curve effect obtained by the CF-guided technique, which improved the ablation electrode-tissue contact in the Blind-group, and (2) repeated provocation and elimination of dormant PV conduction.