CARDIAC TAMPONADE DURING ATRIAL FIBRILLATION ABLATION, BEFORE AND AFTER INTRODUCTION OF CONTACT FORCE SENSING CATHETERS

Abstract

Introduction of the contact force (CF) sensing ablation catheter has been hypothesized to decrease rates of cardiac tamponade during atrial fibrillation (AF) ablation. While conventional radiofrequency ablation catheters have well established tamponade rates of 1-3%, data demonstrating the rates of tamponade with CF sensing ablation catheters is more limited. We sought to assess the incidence of cardiac tamponade before and after the introduction of the Smart-Touch™ (CARTO, Biosense Webster) CF sensing ablation catheter at our institution. All patients undergoing AF ablation procedures from January 1, 2010 to September 2, 2016 at the University of Ottawa Heart Institute (UOHI) were included. All ablation procedures performed with a conventional non-CF ablation catheter were completed before February 7, 2014. After this date all procedures were performed with a Smart-Touch™ CF ablation catheter in the absence of other deliberate changes of technique. All data were collected utilizing a prospective database. We also analyzed potential patient, operator, and procedural risk factors for tamponade. Note that all procedures were performed on interrupted oral anti-coagulation. Five hundred and ninety patients underwent 883 AF ablation procedures. Mean age was 62 years, 72% were male, and 72% had paroxysmal AF. Prior to the introduction of the Smart-Touch™ CF sensing ablation catheter 462 procedures were performed, with 9 tamponade events (9/462,1.9%). After the introduction of Smart-Touch™, 421 procedures were performed with 3 tamponade events (3/421, 0.7%, P=0.148). Analysis of other potential predictors is shown in Table 1. The only factor that was statistically significant was use of bridging heparin (P=0.021). On multivariate analysis this became non-significant (P=0.078). There was no significant difference in frequency of tamponade before and after introduction of contact force sensing catheters (1.9% v.s 0.7%, P=0.148).