Impact of Catheter Contact Angle on Lesion Formation and Durability of Pulmonary Vein Isolation

Abstract

Objectives: This study aimed to evaluate the impact of catheter contact angle on lesion formation and durability of pulmonary vein isolation (PVI). Background: Little is known on the effect of catheter contact angle on lesion formation and durability of PVI. Methods: Both in vitro experiment and retrospective observational study were conducted. For in vitro experiment, radiofrequency lesions were created on explanted swine hearts in three different catheter contact angles (0{degree sign}, 45{degree sign}, and 90{degree sign}). In the retrospective observational study, we assessed patients who had undergone repeat catheter ablation due to atrial fibrillation recurrence after initial PVI. When pulmonary vein (PV) reconnection was observed, we analyzed the previous ablation points within and without the gap area. The gap areas were where ablation had changed the PV activation sequence or eliminated the PV potential in the repeat session. Results: In the in vitro experiment, lesion width was the smallest (5.3 {plus minus} 0.4 mm) in perpendicular contact compared to 0{degree sign} (vs 5.8 {plus minus} 0.5 mm, p=0.040) and 45{degree sign} (vs 6.4 {plus minus} 0.4 mm, p<0.001). In the retrospective observational study, we assessed 666 tags of 16 patients with PV reconnections, and 60 tags were in the gap area. Tags in the gap area had longer interlesion distance (odds ratio [OR] 1.49, p < 0.001), greater contact force variability (OR 1.03, p = 0.008), and higher rate of perpendicular contact (OR 3.26, p < 0.001) on multivariate analysis. Conclusion:Perpendicular contact was associated with a smaller lesion and higher rate of PV reconnection