Highlights
- •We compare the contact force, force–time integral, and impedance in an operator-blinded fashion.
- •The average contact force is significantly higher when using the Agilis™ sheaths.
- •The average contact force is significantly correlated with the change in impedance during ablation.
- •Both average contact force and impedance decrease are significantly lower in inadequate ablation, but only when using the Swartz™ sheaths.
- •Contact force for pulmonary vein isolation is significantly different depending on the position of the catheter and the type of sheath.
Abstract
Background
We performed contact force (CF) monitoring during pulmonary vein (PV) isolation to
evaluate CF according to sheath type, catheter position, and inadequate ablation.
Methods
Thirty consecutive patients (paroxysmal atrial fibrillation, 23; CHADS2 score, 0.5 ± 0.7; age, 56 ± 10 years) who underwent PV isolation using a CF-sensing catheter were included. Data
for operator-blinded CF, impedance, and duration of the “first touch” (first round
of ablation in each PV) was collected. We compared the CF, maximum CF, force–time
integral, average impedance, and impedance drop (Δ impedance) between different sheaths
(Swartz™ vs. Agilis™) in 12 different catheter positions, and in inadequate first
touches requiring additional ablation.
Results
A total of 1283 ablation points (Swartz™, 620 points; Agilis™, 663 points) were evaluated.
The average CF was significantly higher in the Agilis™ group (17.8 ± 13.0 g) than the Swartz™ group (15.0 ± 12.4 g; P < 0.001), especially in the anterior, inferior-anterior, and inferior-posterior sections
of the right PV, and the top of the roof, and calina of the left PV. The Δ impedance
showed a mildly significant negative relationship with the average CF (r = −0.206; P < 0.001) and with the force–time integral (r = −0.279; P < 0.001). Compared to first touches, the average CF and Δ impedance were significantly
smaller in inadequate first touches in the Swartz™ group, but not in the Agilis™ group.
Conclusions
CF for PV isolation was significantly different depending on the position of the catheter
and the type of sheath.
Keywords
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References
- Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus.Circ Arrhythm Electrophysiol. 2008; 1: 354-362
- Characterization of the impact of catheter-tissue contact force in lesion formation during cavo-tricuspid isthmus ablation in an experimental swine model.Europace. 2014; 16: 1679-1683
- Area under the real-time contact force curve (force–time integral) predicts radiofrequency lesion size in an in vitro contractile model.J Cardiovasc Electrophysiol. 2010; 21: 1038-1043
- Importance of catheter contact force during irrigated radiofrequency ablation: evaluation in a porcine ex vivo model using a force-sensing catheter.J Cardiovasc Electrophysiol. 2010; 21: 806-811
- Catheter tip force required for mechanical perforation of porcine cardiac chambers.Europace. 2011; 13: 277-283
- Assessment of catheter tip contact force resulting in cardiac perforation in swine atria using force sensing technology.Circ Arrhythm Electrophysiol. 2011; 4: 218-224
- A novel radiofrequency ablation catheter using contact force sensing: Toccata study.Heart Rhythm. 2012; 9: 18-23
- Relationship between the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in a sleep laboratory referral population.Nat Sci Sleep. 2013; 5: 15-21
- In vivo contact force analysis and correlation with tissue impedance during left atrial mapping and catheter ablation of atrial fibrillation.Circ Arrhythm Electrophysiol. 2014; 7: 46-54
- Locations of high contact force during left atrial mapping in atrial fibrillation patients: electrogram amplitude and impedance are poor predictors of electrode-tissue contact force for ablation of atrial fibrillation.Circ Arrhythm Electrophysiol. 2013; 6: 746-753
- Effect of respiration on catheter-tissue contact force during ablation of atrial arrhythmias.Heart Rhythm. 2012; 9 ([1041-7 e1])
- Predictive value of impedance changes for real-time contact force measurements during catheter ablation of atrial arrhythmias in humans.Heart Rhythm. 2013; 10: 962-969
- Catheter-tissue contact force determines atrial electrogram characteristics before and lesion efficacy after antral pulmonary vein isolation in humans.J Cardiovasc Electrophysiol. 2014; 25: 122-129
- Initial impedance decrease as an indicator of good catheter contact: insights from radiofrequency ablation with force sensing catheters.Heart Rhythm. 2014; 11: 194-201
- Ablation effect indicated by impedance fall is correlated with contact force level during ablation for atrial fibrillation.J Cardiovasc Electrophysiol. 2013; 24: 1210-1215
- Target indices for clinical ablation in atrial fibrillation: insights from contact force, electrogram, and biophysical parameter analysis.Circ Arrhythm Electrophysiol. 2014; 7: 63-68
- Clinical impact of an open-irrigated radiofrequency catheter with direct force measurement on atrial fibrillation ablation.Pacing Clin Electrophysiol. 2012; 35: 1312-1318
- Catheter-tissue contact force for pulmonary veins isolation: a pilot multicentre study on effect on procedure and fluoroscopy time.Europace. 2014; 16: 335-340
- Real-time contact force sensing for pulmonary vein isolation in the setting of paroxysmal atrial fibrillation: procedural and 1-year results.J Cardiovasc Electrophysiol. 2014; 25: 130-137
- The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study.Heart Rhythm. 2012; 9: 1789-1795
- Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study.Circ Arrhythm Electrophysiol. 2013; 6: 327-333
- Quantitative magnetic resonance imaging analysis of the relationship between contact force and left atrial scar formation after catheter ablation of atrial fibrillation.J Cardiovasc Electrophysiol. 2014; 25: 138-145
- Impact of real-time contact force and impedance measurement in pulmonary vein isolation procedures for treatment of atrial fibrillation.Clin Res Cardiol. 2014; 103: 97-106
- Effect of catheter movement and contact during application of radiofrequency energy on ablation lesion characteristics.J Interv Card Electrophysiol. 2013; 38: 123-129
Article info
Publication history
Published online: October 03, 2014
Accepted:
September 28,
2014
Received in revised form:
September 20,
2014
Received:
June 26,
2014
Footnotes
☆Acknowledgement of grant support: None.
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
