Abstract
ObjectiveReconduction across an ablation line is a common reason for arrhythmia recurrence over time. The hybrid procedure combines epicardial ablation of the pulmonary vein (PV) and creation of a box lesion with endocardial touch-ups for any electrical gaps. A high contact force (CF) between the ablation tip and cardiac tissue may increase the risk of thrombus formation, catheter tip charring, steam pop formation, and even cardiac perforation. CF monitoring is a significant new parameter for titration of the CF for creating an adequate lesion.MethodsThirty-eight consecutive patients underwent epicardial ablation using bipolar radiofrequency devices. After checking electrical bidirectional block of the ablation lines, an endocardial CF catheter was used for further ablation (if needed) to complete the isolation of PVs, box lesion, cavotricuspid isthmus (CTI), and complex fractionated atrial electrograms (CFAE).ResultsEndocardial touch-up was needed for 2 PVs (1.3 %) and 10 (26.3 %) box lesions. It was also used for the CTI line in 7 (18.4 %) patients, atrial tachycardia in 3 (7.9 %) patients, and additional CFAE ablation in 17 (44.7 %) patients. All 5 patients with arrhythmia recurrence had a mean CF < 10 g (p = 0.03). Procedure duration was significantly shorter in the CF group (223 ± 57 vs. 256 ± 60 min, p = 0.03) compared with control group.ConclusionUse of CF catheters is safe, feasible, and complementary to a hybrid procedure setup for atrial fibrillation ablation. Its real-time monitoring may predict future arrhythmia recurrence, and decrease procedure time.
Highlights
Atrial fibrillation (AF) is the most common arrhythmia globally affecting more than 20 million people and is a leading cause of stroke among people 65 years and older [1].During catheter ablation for a cardiac arrhythmia, energy is delivered to areas of interest of the heart muscle that are causing the abnormal heart rhythm
The hybrid procedure combines the epicardial ablation of pulmonary vein (PV) and creation of the box lesion by the cardiac surgeon and endocardial touch-ups to ensure ablation of any missed electrical gaps, by the electrophysiologist [3,4,5]
Epicardial bipolar radiofrequency devices were used for 150 PVs (100 %) and box lesions (100 %) for patients
Summary
During catheter ablation for a cardiac arrhythmia, energy is delivered to areas of interest of the heart muscle that are causing the abnormal heart rhythm. Reconduction across an ablation line is one of the most frequent reasons for arrhythmia recurrence over time, e.g. pulmonary vein (PV), and linear lesions [2]. To create a transmural lesion, contact force (CF) between the ablation tip and cardiac tissue is a major determining parameter for radiofrequency catheters, its monitoring assumes significance [6]. Low CF may lead to an inadequate lesion. If it is very high, it may increase the risk of significant complications such as
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