Paroxysmal AF Catheter Ablation With a Contact Force Sensing Catheter

Natale, Andrea; Reddy, Vivek Y.; Monir, George; Wilber, David J.; Lindsay, Bruce D.; McElderry, H. Thomas; Kantipudi, Charan; Mansour, Moussa; Melby, Daniel P.; Packer, Douglas L.; Nakagawa, Hiroshi; Zhang, Baohui; Stagg, Robert B.; Boo, Lee Ming; Marchlinski, Francis E.

doi:10.1016/j.jacc.2014.04.072

Cited by 449 publications

(341 citation statements)

References 21 publications

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“…The recommendations of CF parameters in PVI procedures include a target average CF value of 10-30 g and a minimum FTI value of 400 g for each RF lesion. 5,14,15 Another landmark study, TOCCASTAR by Reddy et al, confirmed the importance of using CF-guided strategies in meeting primary safety and effectiveness endpoints in PVI ablation procedures. 16 In results published by Neuzil et al, 10 evidence has been offered that supports the concept that an LSI of greater than 5 predicts reconnection risk in PVI ablation.…”

Section: Discussionmentioning

confidence: 94%

Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Boles

Gül

Fitzpatrick

et al. 2017

JICRM

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ABSTRACT. The application of optimum contact force (CF) can be used to improve ablation procedure success and safety. The lesion size index (LSI) is a novel dimensionless contact force parameter that allows for an accurate estimation of lesion volume in real time by integrating contact force (grams), duration (seconds) and power (watts). The aim was to correlate LSI values with current contact force parameters to achieve successful and safe bidirectional block of the cavotricuspid isthmus (CTI) using a maximum voltage-guided (MVG) ablation strategy. Fifteen consecutive patients (age 69±7.9 years, nine males) with symptomatic atrial flutter (AFL) were evaluated and compared with 23 control (age 66.3 ± 10.4 years, 16 males) non-contact forceguided ablation cases. Irrigated-tip force-sensing ablation catheters (TactiCath Quartzt, St. Jude Medical, St. Paul, MN, USA) were used in the CF group to achieve the primary endpoint of complete bidirectional block of the isthmus. In the CF group, a total of 233 radiofrequency (RF) applications were examined. A mean LSI of 6.4 ± 1.0 correlated with a force-time integral (FTI) of 581.2±230.9 g/s and an average CF of 13.9±4.9 g concurrently. Intraprocedural, fluoroscopy time and RF time demonstrated lower trends in the CF group, but no significance with respect to these trends was observed. The secondary endpoint of no reconnection within 20 min after the procedure was equally attained in both groups, and, likewise, the level of safety was comparable. An LSI value of 45 represents a new effective parameter in MVG ablation for the cavotricuspid region that demonstrates a safe profile. Guidance of CTI ablation using LSI and other contact force parameters of CF 13.9 ± 4.9 g and FTI 581.2 ± 230.9 g/s demonstrated highly effective and safe outcomes.

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Section: Discussionmentioning

confidence: 94%

Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Boles

Gül

Fitzpatrick

et al. 2017

JICRM

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“…In ablation the creation of LA transmural lesions and sufficient contact-force are fundamental success criteria [2,30,31], and pre-procedural information about LAWT, regional differences, PV CSA , PV variants and LAV allow the ablation operator to customize and individualize treatment and ablation strategy to ensure durable PV-isolation. In each case, procedure focus could be directed towards the thickest parts of the LA, which may require most intensive ablation and also the thinnest areas, where perforation risk and risk of collateral damage may be higher.…”

Section: Pulmonary Vein Cross-sectional Areamentioning

confidence: 99%

Left Atrial Wall Thickness and Pulmonary Vein Size are Increased in Patients with Atrial Fibrillation Compared to Healthy Controls - A Multidetector Computed Tomography Study

Thomsen¹

2017

Int J Clin Cardiol

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“…Although most studies have shown similar or even fewer complications associated with the use of real-time CF sensing catheters compared with non-CF sensing catheters, these studies have all been relatively underpowered to detect small differences in complications. Excessive CF has been associated with perforation 14 and tamponade, 15 and perhaps atrioesophageal fistula, 19 thus underlining the importance of optimising CF.…”

Section: Diagnostic Electrophysiology and Ablationmentioning

confidence: 99%

Evolution of Force Sensing Technologies

Shah

2017

Arrhythmia &Amp; Electrophysiology Review

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In order to improve the procedural success and long-term outcomes of catheter ablation techniques for atrial fibrillation (AF), an important unfulfilled requirement is to create durable electrophysiologically complete lesions. Measurement of contact force (CF) between the catheter tip and the target tissue can guide physicians to optimise both mapping and ablation procedures. Contact force can affect lesion size and clinical outcomes following catheter ablation of AF. Force sensing technologies have matured since their advent several years ago, and now allow the direct measurement of CF between the catheter tip and the target myocardium in real time. In order to obtain complete durable lesions, catheter tip spatial stability and stable contact force are important. Suboptimal energy delivery, lesion density/ contiguity and/or excessive wall thickness of the pulmonary vein-left atrial (PV-LA) junction may result in conduction recovery at these sites. Lesion assessment tools may help predict and localise electrical weak points resulting in conduction recovery during and after ablation. There is increasing clinical evidence to show that optimal use of CF sensing during ablation can reduce acute PV re-conduction, although prospective randomised studies are desirable to confirm long-term favourable clinical outcomes. In combination with optimised lesion assessment tools, contact force sensing technology has the potential to become the standard of care for all patients undergoing AF catheter ablation.

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Paroxysmal AF Catheter Ablation With a Contact Force Sensing Catheter

Cited by 449 publications

References 21 publications

Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Left Atrial Wall Thickness and Pulmonary Vein Size are Increased in Patients with Atrial Fibrillation Compared to Healthy Controls - A Multidetector Computed Tomography Study

Evolution of Force Sensing Technologies

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