Atrial rhythm influences catheter tissue contact during radiofrequency catheter ablation of atrial fibrillation: comparison of contact force between sinus rhythm and atrial fibrillation.

Hisao Matsuda,Wilhelm Haverkamp,Alexander Wutzler,Florian Blaschke,Philipp Attanasio,Martin Huemer,Abdul Shokor Parwani,Leif-Hendrik Boldt

doi:10.1007/s00380-015-0763-0

Hisao Matsuda, Wilhelm Haverkamp + Show 6 more

Open Access

https://doi.org/10.1007/s00380-015-0763-0

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Journal: Heart and vessels	Publication Date: Oct 26, 2015
Citations: 37	License type: CC BY 4.0

Affiliation: Charité - Universitätsmedizin Berlin

Abstract

Catheter tissue contact force (CF) is an important factor for durable lesion formation during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF). Since CF varies in the beating heart, atrial rhythm during RFCA may influence CF. A high-density map and RFCA points were obtained in 25 patients undergoing RFCA of AF using a CF-sensing catheter (Tacticath, St. Jude Medical). The operators were blinded to the CF information. Contact type was classified into three categories: constant, variable, and intermittent contact. Average CF and contact type were analyzed according to atrial rhythm (SR vs. AF) and anatomical location. A total of 1364 points (891 points during SR and 473 points during AF) were analyzed. Average CFs showed no significant difference between SR (17.2 ± 11.3 g) and AF (17.2 ± 13.3 g; p = 0.99). The distribution of points with an average CF of ≥20 and <10 g also showed no significant difference. However, the distribution of excessive CF (CF ≥40 g) was significantly higher during AF (7.4 %) in comparison with SR (4.2 %; p < 0.05). At the anterior area of the right inferior pulmonary vein (RIPV), the average CF during AF was significantly higher than during SR (p < 0.05). Constant contact was significantly higher during AF (32.2 %) when compared to SR (9.9 %; p < 0.01). Although the average CF was not different between atrial rhythms, constant contact was more often achievable during AF than it was during SR. However, excessive CF also seems to occur more frequently during AF especially at the anterior part of RIPV.

Highlights

Radiofrequency catheter ablation (RFCA) is an accepted treatment option for symptomatic and drug resistance atrial fibrillation (AF) [1]
Our study has demonstrated that (1) average contact force (CF) showed no significant difference between sinus rhythm (SR) and AF; (2) regardless of the atrial rhythm, there was a high variability of average CF; (3) there was no significant difference in the ratio of either low contact or sufficient contact; the ratio of excessive contact was significantly higher during AF than during SR; (4) constant contact was more often achievable during AF than during SR; (5) there was no significant difference in the average CF between atrial rhythms according to the anatomical location except at the right inferior pulmonary vein (RIPV) anterior area
We have shown here that low contact occurs during both atrial rhythms to the same degree (p = 0.18), and only 34 % points were categorized as sufficient contact during both atrial rhythms (34.6 % during SR, 34.2 % during AF, p = 0.51) when operators are blinded to CF information

Summary

Introduction

Radiofrequency catheter ablation (RFCA) is an accepted treatment option for symptomatic and drug resistance atrial fibrillation (AF) [1]. Besides power and duration of RF delivery, catheter tissue contact has been shown to be an important factor for lesion size, transmurality and durable lesion formation during RFCA of AF [2]. During PVI, an average CF of ≥20 g is an optimal target to avoid insufficient lesion formation, while an average CF of

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