Premium
Impact of Contact Force Monitoring in Acute Pulmonary Vein Isolation Using an Anatomic Approach. A Randomized Study
Author(s) -
PEDROTE ALONSO,
ARANARUEDA EDUARDO,
ARCELEÓN ALVARO,
ACOSTA JUAN,
GÓMEZPULIDO FEDERICO,
MARTOSMAINE JOSÉ LUIS,
FRUTOSLÓPEZ MANUEL,
SÁNCHEZBROTONS JUAN,
GARCÍARIESCO LORENA
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12811
Subject(s) - medicine , catheter , pulmonary vein , catheter ablation , atrial fibrillation , ablation , nuclear medicine , cardiology , surgery
Background The impact of contact force (CF) monitoring in pulmonary vein (PV) isolation after a circumferential anatomic ablation (CAA) is unknown. We analyze the usefulness of CF monitoring in acute PV isolation and procedure parameters using a CAA. Methods Fifty patients with paroxysmal atrial fibrillation were randomized into CF‐on (CF >10 grams; n = 25) or CF‐off (CF blinded; n = 25) groups. We performed a first round of CAA with a ThermoCool ® SmartTouch ® catheter blinded to the LASSO ® catheter (Biosense Webster, Diamond Bar, CA, USA), with radiofrequency (RF) lesions tagged with the VisiTag ™ Module. After the CAA, each PV was reviewed with the LASSO ® catheter recording the segments with gaps. Results All the PVs were isolated with a CAA in 20 patients of the CF‐on versus eight of the CF‐off (P = 0.001). Of the 45 segments with gaps in the left PVs, 38 were from the CF‐off (P = 0.0001). Of the eight segments with gaps in the right PVs, seven were from the CF‐off (P = 0.06). The CF in the left PVs was higher in the CF‐on (16.3 ± 3.2 grams vs 10.5 ± 4.3 grams; P = 0.0001) and similar in the right PVs (17.6 ± 3.6 grams vs 15.2 ± 5.3 grams; P = 0.08). All of the gaps were closed with additional RF LASSO ® ‐guided touch‐up. Procedure and fluoroscopy times were shorter in the CF‐on (139 ± 24 minutes vs 157 ± 32 minutes and 20 ± 6 minutes vs 24 ± 7 minutes; both P = 0.039). At 12 months the AF recurrence was 84% CF‐on versus 75% CF‐off (log‐rank P = 0.4). Conclusions In paroxysmal atrial fibrillation, a CAA guided by CF reduces PV gaps and shortens the procedure parameters at the expense of the left PVs.