Benefit of Contact Force–Guided Catheter Ablation for Treating Premature Ventricular Contractions

Abstract

We evaluated whether an irrigated contact force–sensing catheter would improve the safety and effectiveness of radiofrequency ablation of premature ventricular contractions originating from the right ventricular outflow tract. We retrospectively reviewed the charts of patients with symptomatic premature ventricular contractions who underwent ablation with a contact force–sensing catheter (56 patients, SmartTouch) or conventional catheter (59 patients, ThermoCool) at our hospital from August 2013 through December 2015. During a mean follow-up of 16 ± 5 months, 3 patients in the conventional group had recurrences, compared with none in the contact force group. Complications occurred only in the conventional group (one steam pop; 2 ablations suspended because of significantly increasing impedance). In the contact force group, the median contact force during ablation was 10 g (interquartile range, 7–14 g). Times for overall procedure (36.9 ± 5 min), fluoroscopy (86.3 ± 22.7 s), and ablation (60.3 ± 21.4 s) were significantly shorter in the contact force group than in the conventional group (46.2 ± 6.2 min, 107.7 ± 30 s, and 88.7 ± 32.3 s, respectively; P <0.001). In the contact force group, cases with a force-time integral <560 gram-seconds (g-s) had significantly longer procedure and fluoroscopy times (both P <0.001) than did those with a force-time integral ≥560 g-s. These findings suggest that ablation of premature ventricular contractions originating from the right ventricular outflow tract with an irrigated contact force–sensing catheter instead of a conventional catheter shortens overall procedure, fluoroscopy, and ablation times without increasing risk of recurrence or complications.

Contact Force-Sensing versus Standard Catheters in Non-Fluoroscopic Radiofrequency Catheter Ablation of Idiopathic Outflow Tract Ventricular Arrhythmias

“…Recent publications have demonstrated the safety and efficacy of NF-RFCA in OT arrhythmias, but the role of CFS catheters in this setting is unknown [1,4,5]. The results of our study show no advantages of CFS over standard catheters in NF-RFCA of OT-VAs, in keeping with previous publications concerning the same arrhythmia type but performed with fluoroscopy guidance [14,15,18]. Reichlin et al [14] and Abraham et al [15] compared the effectiveness and safety of CFS vs. standard catheters and showed similar outcomes in LVOT and RVOT arrhythmia ablation.…”

“…Additionally, in the TOCCATA study, cardiac perforation was linked to excessive CF based on blinded CFS measurements [19]. On the contrary, in previously published data and our study results, there is no evidence of the significant implication of the CFS catheter on safety during ventricular RFCA, independent of the presence of structural heart disease, arrhythmia localization, or fluoroscopy use [14,15,18,[24][25][26]. Novel techniques are introduced in cardiac electrophysiology [27].…”

“…Reichlin et al [14] and Abraham et al [15] compared the effectiveness and safety of CFS vs. standard catheters and showed similar outcomes in LVOT and RVOT arrhythmia ablation. In other studies, the use of CFS catheters only shortened a procedural, fluoroscopy and ablation time [18]. Conversely, we observed a longer procedural time in the CFS guidance group which might be explained by often time-consuming attempts to achieve intended CF (>10 g) with relatively stiffer CFS catheters compared to standard ones and also time needed for CFS catheters calibration, which should be done after CFS catheter introduction and every time when the operator makes a decision to map and/or ablate another ventricle during NF-RFCA of OT-VAs.…”

Catheter ablation of ventricular tachycardia: strategies to improve outcomes

“…One of the major technological advancements was the development of sensors at the distal tip capable of monitoring contact, contact force (CF) ( 84 , 85 ). During VT ablation, a median contact force of 10 g within the scar zone has been shown to have the best correlation with effective lesion formation ( 86 , 87 ). Although there is also evidence that contact force sensing catheters may not change long-term outcomes, it is important that we continue to explore markers of ablation efficacy ( 88 ).…”

Impact of catheter ablation procedure on optical coherence tomography angiography findings in patients with ventricular arrhythmia

“…Catheter ablation (CA) by radiofrequency is the most effective treatment modality for ventricular arrhythmias (VAs) as premature ventricular contractions or ventricular tachycardia 1 - 4 . However, endocardial CA procedures may cause cardiac complications 5 , 6 as well as cerebral 7 , 8 and ocular 9 complications.…”