First pass isolation predicts clinical success after contact force guided paroxysmal atrial fibrillation ablation

Abstract

Abstract Background Contact force (CF) ablation of AF with a focus on catheter-tissue contact stability optimizes clinical success and may help the operator to achieve pulmonary vein (PV) isolation in a single encirclement. While it seems evident that first pass isolation reduces procedure time, the effect on long term clinical success has not been reported. Purpose To evaluate the relationship between first pass isolation and freedom from atrial tachyarrhythmia recurrence at 1 year after PAF ablation. Methods Consecutive de novo PAF ablations were performed with a porous tip contact force catheter in 2017. All ablations used wide-area circumferential ablation and first pass isolation was captured separately for the left and right PVs. CF was held between 10–20 g and the catheter was moved every 10–20 s. RF energy was set at 40W throughout the atrium. Clinical success was defined as freedom from recurrent atrial tachyarrhythmia through 1 year following a 90-day blanking period and freedom from reablation at any time through 1 year. Results The population included 157 patients, age 62.7±11.5, 54.8% male, with mean CHA2DS2-VASc score of 2.3±1.5. Mean procedure times were 76.2±29.8 minutes and 89.2% of the ablations were performed with no fluoroscopy. The overall clinical success rate at 1 year was 86.1%. The number of ipsilateral PV pairs that could be isolated in a single pass was significantly associated with 1-year success (p=0.0043). Achieving first pass isolation on even one ipsilateral PV pair vs. neither pair was significantly associated with clinical success (Table). Conclusion In a real-world setting, first pass isolation on at least one PV side was predictive of 1 year clinical success in a PAF population ablated with CF. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Biosense Webster, Inc.