Abstract
Introduction: Monitoring contact force (CF) during ablation would facilitate the procedure of circumferential pulmonary vein (PV) isolation (CPVI). To evaluate the advantage of real-time CF information, we compared the ablation procedure parameters between CF-guided and non-guided CPVI. Methods: The consecutive 31 patients (24 men; mean age, 60 years; 7 with persistent AF) were randomly assigned to CF-guided (CF group, n=17) and CF-non-guided ablation groups (non-CF, n=14). After image integration of CartoSound image of the left atrium (LA) into computed tomography LA image, CPVI was performed using a Thermcool Smarttouch catheter in both groups. In CF group, the operator attempted to keep CF between 10 and 20 g at each ablation site, while in non-CF group, CF information was blinded to the operator. The endpoint of CPVI was the elimination of all PV potentials recorded by circular catheter placed at the PV ostium and PV-to-LA block during pacing from 10 pairs of circular catheter done during sinus rhythm. CF map along CPVI line was created and was divided into 8 segments in each left and right PVs. CPVI procedure and fluoroscopy times, CF in each segment and the number of additional touch-up ablation to complete CPVI were compared between the 2 groups. Results: CPVI was achieved in all patients without any complications. The procedure time for CPVI in non-CF and CF groups were 80±26 and 57±16 minutes (p < 0.001), respectively, and both median fluoroscopy times 0 second (25 to 75%, 0 to 8 and 0 to 0 sec, respectively, p=0.34.) CFs at the anterior segment of the left PV in non-CF group was 4.9±2.8 g, and was significantly smaller than that in CF group (10.6±4.1 g, p < 0.001) The numbers of touch-up ablation in non-CF and CF groups were 6.6±2.8 and 2.9±1.9, respectively (p < 0.001). Conclusion: CF-guided CPVI is effective in reducing the procedure time and additional touch-up ablation, presumably by forming a larger lesion compared with CF non-guided ablation.
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