Introduction: Pre-clinical work suggests factors including catheter orientation and contact consistency during individual radiofrequency ablations influence lesion size and that impedance drop during ablation correlates with the lesion size. Our aim was to investigate factors affecting catheter contact in the human left atrium (LA) and their effects on ablation. Methods and Results: 2,900 eight second static LA mapping points were studied in 30 patients undergoing ablation for AF: 16 patients in AF, 14 in sinus rhythm (SR), 18 remote robotic navigation (RRN) procedures. A SmartTouch contact force (CF) sensing catheter (Biosense Webster, USA) was used to collect CF data. All data were analysed using custom written scripts in the Matlab (MathWorks, USA) environment. CF variability (CFV: difference between 20Hz-sampled CF waveform mean peak and trough) increased with mean CF (Spearman's rho 0.6, p<0.005), and varied by location, being highest at the LA roof. Catheter drift correlated weakly with CF (Spearman's rho −0.05, p=0.005). CFV and drift were higher in SR than AF (p<0.001 for each). In AF there was less catheter drift for RRN than manual navigation points but the converse was true in SR (p<0.001 for both). CFV was higher with RRN (p<0.005). In 747 static 30s LA ablations, the influence of contact parameters on ablation efficacy was compared by multivariate analysis of impedance drop during ablation: a lesser drop suggesting reduced efficacy (Table). Greater CFV, locational drift, perpendicular contact, SR and RRN usage were associated with reduced efficacy (p<0.005 for each), even with ablation force time integral included in this analysis. Dependent Variable: Square root of percentage impedance drop Reference Location: Right WACA A positive β value for a co-factor means that if all the other co-factors are unchanged, the impedance drop will be higher as the co-factor increases (and vice versa) . Conclusions: Beyond ablation CF magnitude and duration, the quality of catheter contact also influences ablation efficacy. Clinical catheter contact is affected by multiple factors, including contact orientation, atrial rhythm and catheter navigation mode. Ablations should be performed in parallel contact with CFV ≤10g and catheter drift ≤3.5mm to maximize efficacy. | Multivariate analysis of factors affecting impedance drop during ablation | |:-------------------------------------------------------------------------:| ------------------------------------------ | | Co-factor | Unstandardized β (95% Confidence Interval) | p-value | | Ln(Force Time Integral) g.s | 0.78 (0.77 to 0.78) | <0.005 | | Remote Robotic Navigation | −0.08 (−0.1 to −0.07) | <0.005 | | Catheter drift >3.5mm | −0.22 (−0.24 to −0.2) | <0.005 | | Contact Force Variability (g) | −0.03 (−0.03 to −0.02) | <0.005 | | Perpendicular Contact Orientation | −0.03 (−0.04 to −0.02) | <0.005 | | Sinus Rhythm | −0.07 (−0.09 to 0.05) | <0.005 | | Left Atrial Body (non-WACA) | 0.1 (0.08 to 0.11) | <0.005 | | Left WACA | 0.06 (0.05 to 0.07) | <0.005 |