Choice of Steerable Sheath Impacts Contact Force Stability During Pulmonary Vein Isolation

Abstract

Purpose: A stable contact force (CF) is correlated with more effective radiofrequency ablation (RFA) lesions and long-term procedural outcomes. Efforts to improve catheter stability include jet ventilation, pacing, steerable sheaths, and CF sensing ablation catheters. This study compares CF stability and effective RF lesions between two commercially available steerable sheaths. Methods: Thirty patients underwent first time RFA at a single center using the Agilis NxT or SureFlex Steerable Sheath. High power short duration RFA was utilized targeting a 10Ω drop. Sheath performance was assessed for the entire procedure and around each pulmonary vein (PV) in terms of mean CF, CF variability, RF time per lesion, and inefficient contact lesions (defined as lesions with CF < 5g for at least 10% of the RF delivery time). Results: Operator-targeted mean CF was achieved using both sheaths; however, overall CF variability was 12.8% lower using the SureFlex sheath (p = 0.08). CF variability was generally 16% greater in the right PVs than the left PVs (p = 0.001), but trended lower with the SureFlex sheath. There were 8% more inefficient contact lesions using Agilis as compared to SureFlex (p = 0.035), especially in the right inferior PV (p = 0.009). RF time per lesion was on average 12% (1.4s) shorter using SureFlex than Agilis (p < 0.05). Conclusion: Choice of steerable sheath may affect catheter stability and potential lesion quality, especially in the right PVs.

Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: A systematic review and meta‐analysis

“…Again, the occurrence rate is too low to draw any firm conclusions about the SS technology's safety. Our results on the safety profile are consistent with Hiner and Shah, who examined the utility of two commercially available SS on CF stability during PVI and found no major procedure‐related adverse effects 31 . Furthermore, no procedure‐related complications were found in an RCT that comprised patients with typical atrial flutter and nine patients with persistent AF who received cavotricuspid isthmus ablation 32 .…”

“…Our results on the safety profile are consistent with Hiner and Shah, who examined the utility of two commercially available SS on CF stability during PVI and found no major procedure-related adverse effects. 31 Furthermore, no procedure-related complications were found in an RCT that comprised patients with typical atrial flutter and nine patients with persistent AF who received cavotricuspid isthmus ablation. 32 Other RF ablation techniques, such as high power and short duration (HPSD), are also available, in which a higher CF can cause steam pop.…”