nach oben

Erschienen in:

02.03.2018 | Original Paper

Contact force facilitates the achievement of an unexcitable ablation line during pulmonary vein isolation

verfasst von: Benjamin Schaeffer, Stephan Willems, Christian Meyer, Jakob Lüker, Ruken Ö. Akbulak, Julia Moser, Mario Jularic, Christian Eickholt, Jana M. Schwarzl, Melanie Gunawardene, Pawel Kuklik, Arian Sultan, Boris A. Hoffmann, Daniel Steven

Erschienen in: Clinical Research in Cardiology | Ausgabe 8/2018

Einloggen, um Zugang zu erhalten

Abstract

Aims

Contact force (CF) catheters provide catheter-tissue contact information to improve outcome of pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF). We evaluated different target-CF values for achievement of the additional endpoint of an unexcitable ablation line.

Methods

A total of 106 patients undergoing PVI were randomized into three groups (G) (G1: target-CF 15 g, G2: target-CF 10 g, G3: CF concealed from operator). The PVI encircling line was divided into predefined sections. Excitable tissue along the PVI-line identified by high output pacing (10 V, 2 ms) was targeted for further ablation.

Results

Mean average CF was 17.4 ± 4.7 g (G1) vs. 12.3 ± 6.0 g (G2) vs. 11.1 ± 6.5 g (G 3) (p < 0.001). Primary unexcitable ablation lines were found in 38.6, 19.4 and 5.7% (G1, G2, G3 respectively; G1 vs. G2 p < 0.05, G1 vs. G3 p < 0.001, G2 vs. G3 ns). Additional radiofrequency (RF)-energy to achieve unexcitability was lowest in G1 (3.6 ± 3.1 kJ vs. 8.6 ± 7.2 kJ (G2) and 10.4 ± 6.7 (G3), p ≤ 0.001, G2 vs. G3 ns) with accordingly lowest additional RF applications in G1 (3.0 ± 2.6 vs. 7.0 ± 5.4 in G2 and 8.4 ± 4.0 in G3; G1 vs. G2 and G3, p < 0.001, G 2 vs. G 3 ns). Sections along ablation lines with low initial CF were most likely to reveal excitability. Single procedure success was 81.9 vs. 73.5 vs. 71.4% (G 1, 2 and 3, p = 0.6) during 437 ± 254 day follow-up.

Conclusion

Higher tip-to-tissue CF during PVI facilitates the achievement of an unexcitable ablation line, requiring less additional RF-energy.

Willems S, Steven D, Servatius H, Hoffmann BA, Drewitz I, Müllerleile K et al (2010) Persistence of pulmonary vein isolation after robotic remote-navigated ablation for atrial fibrillation and its relation to clinical outcome. J Cardiovasc Electrophysiol 21(10):1079–1084CrossRefPubMed

Rillig A, Lin T, Schmidt B, Feige B, Heeger C, Wegner J et al (2016) Experience matters: long-term results of pulmonary vein isolation using a robotic navigation system for the treatment of paroxysmal atrial fibrillation. Clin Res Cardiol 105(2):106–116CrossRefPubMed

Kettering K, Yim DH, Benz A, Gramley F (2017) Catheter ablation of paroxysmal atrial fibrillation: Circumferential pulmonary vein ablation: Success rates with and without exclusion of areas adjacent to the esophagus. Clin Res Cardiol 106(9):743–51CrossRefPubMed

Wasmer K, Dechering DG, Köbe J, Mönnig G, Pott C, Frommeyer G et al (2016) Pulmonary vein reconnection and arrhythmia progression after antral linear catheter ablation of paroxysmal and persistent atrial fibrillation. Clin Res Cardiol 105(9):738–743CrossRefPubMed

Sohns C, Saguner AM, Lemes C, Santoro F, Mathew S, Heeger C et al (2016) First clinical experience using a novel high-resolution electroanatomical mapping system for left atrial ablation procedures. Clin Res Cardiol 105(12):992–1002CrossRefPubMed

Nakamura K, Naito S, Sasaki T, Minami K, Take Y, Shimizu S et al (2016) Predictors of chronic pulmonary vein reconnections after contact force-guided ablation: Importance of completing electrical isolation with circumferential lines and creating sufficient ablation lesion densities. J Interv Card Electrophysiol 47(3):321–331CrossRefPubMed

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37(38):2893–2962

Yokoyama K, Nakagawa H, Shah DC, Lambert H, Leo G, Aeby N et al (2008) Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circ Arrhythm Electrophysiol 1(5):354–362CrossRefPubMed

Reddy VY, Shah D, Kautzner J, Schmidt B, Saoudi N, Herrera C et al (2012) The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm 9(11):1789–1795CrossRefPubMed

10.

Kautzner J, Neuzil P, Lambert H, Peichl P, Petru J, Cihak R et al. EFFICAS II: Optimization of catheter contact force improves outcome of pulmonary vein isolation for paroxysmal atrial fibrillation. Europace, 17(8):1229–1235

11.

Afzal MR, Chatta J, Samanta A, Waheed S, Mahmoudi M, Vukas R et al (2015) Use of contact force sensing technology during radiofrequency ablation reduces recurrence of atrial fibrillation: a systematic review and meta-analysis. Heart Rhythm 12(9):1990–1996CrossRefPubMed

12.

Natale A, Reddy VY, Monir G, Wilber DJ, Lindsay BD, McElderry HT et al (2014) Paroxysmal AF catheter ablation with a contact force sensing catheter: Results of the prospective, multicenter SMART-AF trial. J Am Coll Cardiol 64(7):647–656CrossRefPubMed

13.

Steven D, Reddy VY, Inada K, Roberts-Thomson KC, Seiler J, Stevenson WG, Michaud GF (2010) Loss of pace capture on the ablation line: A new marker for complete radiofrequency lesions to achieve pulmonary vein isolation. Heart Rhythm 7(3):323–330CrossRefPubMed

14.

Steven D, Sultan A, Reddy V, Luker J, Altenburg M, Hoffmann B et al (2013) Benefit of pulmonary vein isolation guided by loss of pace capture on the ablation line: results from a prospective 2-center randomized trial. J Am Coll Cardiol Jul 2;62(1):44–50CrossRef

15.

Eitel C, Hindricks G, Sommer P, Gaspar T, Kircher S, Wetzel U et al (2010) Circumferential pulmonary vein isolation and linear left atrial ablation as a single-catheter technique to achieve bidirectional conduction block: the pace-and-ablate approach. Heart Rhythm 7(2):157–64CrossRefPubMed

16.

Schaeffer B, Willems S, Sultan A, Hoffmann BA, Lüker J, Schreiber D et al (2015) Loss of pace capture on the ablation line during pulmonary vein isolation versus “dormant conduction”: is adenosine expendable? J Cardiovasc Electrophysiol 26(10):1075–1080CrossRefPubMed

17.

Gunawardene MA, Hoffmann BA, Schaeffer B, Chung D-U, Moser J, Akbulak RO et al. Influence of energy source on early atrial fibrillation recurrences: a comparison of cryoballoon vs. Radiofrequency current energy ablation with the endpoint of unexcitability in pulmonary vein isolation. Europace 2016, 14

18.

Moser J, Sultan A, Lüker J, Servatius H, Salzbrunn T, Altenburg M et al (2017) 5-Year outcome of pulmonary vein isolation by loss of pace capture on the ablation line versus electrical circumferential pulmonary vein isolation. JACC Clin Electrophysiol 3(11). https://doi.org/10.1016/j.jacep.2017.04.019

19.

Kosmidou I, Houde-Walter H, Foley L, Michaud G (2013) Loss of pace capture after radiofrequency application predicts the formation of uniform transmural lesions. Europace 15(4):601–606CrossRefPubMed

20.

Makimoto H, Lin T, Rillig A, Metzner A, Wohlmuth P, Arya A et al (2014) In vivo contact force analysis and correlation with tissue impedance during left atrial mapping and catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol 7(1):46–54CrossRefPubMed

21.

Ullah W, McLean A, Tayebjee MH, Gupta D, Ginks MR, Haywood GA et al (2016) Randomized trial comparing pulmonary vein isolation using the smarttouch catheter with or without real-time contact force data. Heart Rhythm 13(9):1761–1767CrossRefPubMed

22.

Park CI, Lehrmann H, Keyl C, Weber R, Schiebeling J, Allgeier J et al (2014) Mechanisms of pulmonary vein reconnection after radiofrequency ablation of atrial fibrillation: The deterministic role of contact force and interlesion distance. J Cardiovasc Electrophysiol 25(7):701–708CrossRefPubMed

23.

Okumura Y, Watanabe I, Iso K, Nagashima K, Sonoda K, Sasaki N et al (2016) Clinical utility of automated ablation lesion tagging based on catheter stability information (visitag module of the CARTO 3 system) with contact force-time integral during pulmonary vein isolation for atrial fibrillation. J Interv Card Electrophysiol 47(2):245–252CrossRefPubMed

24.

Rozen G, Ptaszek L, Zilberman I, Cordaro K, Heist EK, Beeckler C et al (2017) Prediction of radiofrequency ablation lesion formation using a novel temperature sensing technology incorporated in a force sensing catheter. Heart Rhythm 14(2):248–254CrossRefPubMed

25.

Das M, Loveday JJ, Wynn GJ, Gomes S, Saeed Y, Bonnett LJ et al (2017) Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. Europace 19(5):775–783PubMed

26.

Gitenay E, O’ Hara GE, Sarrazin J-F, Nault I, Philippon F, Sadron Blaye-Felice M et al (2016) Contact-force catheters: efficacy versus safety? Case report of 2 atrioesophageal fistulae. J Cardiovasc Electrophysiol 27(12):1483–1487CrossRefPubMed

27.

Shurrab M, Di Biase L, Briceno DF, Kaoutskaia A, Haj-Yahia S, Newman D et al (2015) Impact of contact force technology on atrial fibrillation ablation: a meta-analysis. J Am Heart Assoc 4(9):e002476CrossRefPubMedPubMedCentral

Titel: Contact force facilitates the achievement of an unexcitable ablation line during pulmonary vein isolation
verfasst von: Benjamin Schaeffer
Stephan Willems
Christian Meyer
Jakob Lüker
Ruken Ö. Akbulak
Julia Moser
Mario Jularic
Christian Eickholt
Jana M. Schwarzl
Melanie Gunawardene
Pawel Kuklik
Arian Sultan
Boris A. Hoffmann
Daniel Steven
Publikationsdatum: 02.03.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 8/2018
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1228-0

Neu im Fachgebiet Kardiologie

25.04.2024 | Hypotonie | Nachrichten

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Contact force facilitates the achievement of an unexcitable ablation line during pulmonary vein isolation

Abstract

Aims

Methods

Results

Conclusion

Neu im Fachgebiet Kardiologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adipositas-Medikament auch gegen Schlafapnoe wirksam

Komplette Revaskularisation bei Infarkt: Neue Studie setzt ein Fragezeichen

Update Kardiologie

Springer Medizin

Abstract

Aims

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2018

Acute coronary syndrome due to right coronary spasm and documented lambda-like J waves

Unexplained cardiac arrest: a tale of conflicting interpretations of KCNQ1 genetic test results

Predictors of paravalvular regurgitation and permanent pacemaker implantation after TAVR with a next-generation self-expanding device

The why, when and how to test for obstructive sleep apnea in patients with atrial fibrillation

Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials

Indication and short-term clinical outcomes of high-risk percutaneous coronary intervention with microaxial Impella® pump: results from the German Impella® registry

Neu im Fachgebiet Kardiologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adipositas-Medikament auch gegen Schlafapnoe wirksam

Komplette Revaskularisation bei Infarkt: Neue Studie setzt ein Fragezeichen

Update Kardiologie