Superior efficacy of pulmonary vein isolation with online contact force measurement persists after the learning period: a prospective case control study.

Abstract

Use of online contact force (CF) measurement during circumferential pulmonary vein (PV) isolation (CPVI) for atrial fibrillation (AF) has demonstrated improvements in procedural parameters and mid-term clinical outcome. However, it is unknown if experience gained with CF measuring catheters improves the efficacy of subsequent CPVI procedures performed without CF measurement. This prospective trial compared procedural results of CPVI performed without a CF measuring catheter to a control group performed with a CF measuring catheter, by an operator with prior experience with CF technology.. Thirty-six eligible paroxysmal (n = 27) or persistent (n = 9) AF patients were consecutively enrolled. Twelve patients underwent CPVI with the non-CF catheter (CF- group) in a recall period and 24 with the CF catheter (CF+ group). After the first circumferential lesion set, the number of PV pairs requiring additional touch-up lesions to achieve electrical isolation was significantly less in the CF+ group (2 of 48 (4.2%) vs. 7 of 24 (29.2%) in the CF+ and CF- groups, respectively, p = 0.005). The procedure time was significantly lower in the CF+ group (117.9 ± 23.3 vs. 134.1 ± 25.3min, p = 0.033). Radiofrequency (RF) and fluoroscopy time did not differ between groups (31.5 ± 7.1 vs. 31.8 ± 7.0min and 11.8 ± 5.6 vs. 11.0 ± 5.8min in the CF+ and the CF- group, respectively) With the use of online CF measurement, PV isolation is more frequently complete following the first circumferential lesion set. A previous learning period with direct CF feedback is not a substitute for real-time direct CF measurement to maintain this advantage.