Contact force-sensing catheters: performance in an ex vivo porcine heart model.

Abstract

Contact force (CF) catheters are useful to address proper contact during ablation. However, interactions between the ablation process, or its associated irrigation flow changes, with the CF sensing may translate into unexpected CF value fluctuations. We aimed to test for unintentional CF value variations during radiofrequency applications at a fixed applied force, with two commercially available catheters (TactiCath™ and SmartTouch™), and to evaluate its theoretical clinical significance by correlating CF-derived automatic ablation algorithms (force-time integral and lesion index) and actual lesion size at two standard CF values. Four series of 20 perpendicular epicardial ablations (20W, 60s, 17ml/min) were performed on porcine left ventricle submerged in 37°C saline. Catheters were mechanically fixed at a constant position and evaluated at 10 and 20g. CF values were digitally analysed before each application changing irrigation rate (2-17-30ml/min), and during ablation. Finally, lesions were quantified. Increasing irrigation before ablation led to a slight but significant CF decrease. During ablation, CF showed a reproducible pattern: fast initial decrease, subsequent increase until higher-than-initial values and final plateau phase (CF variation up to 69% at 10g). CF variability was significantly higher at 10g and using TactiCath™. There were no major differences in lesion size between catheters at the same initial CF. CF only correlated mildly to lesion measures, and automatic algorithms globally failed to predict lesion size. CF measured values spontaneously vary during ablation following a predictable pattern (initial decrease, subsequent increase and final plateau). This is especially remarkable applying lower CF.