The importance of catheter stability evaluated by VisitagTM during pulmonary vein isolation

BackgroundThe recurrence rates of atrial fibrillation (Af) after ablation are still high, and repeat procedures are required in these patients. The main reason for Af recurrence is the recovery of the conduction between the pulmonary veins and left atrium. The importance of catheter stability during the pulmonary vein isolation (PVI) is not well studied.PurposeThe purpose of this study was to evaluate the contact force (CF), stable ablation time, and power during conduction blocking lesion formation for PVI.MethodsThirty-two consecutive drug-refractory Af patients who underwent an initial PVI using CARTO 3 and Visitag were included. The CF, ablation time, force time integral (FTI), and ablation power were recorded by Visitag. Residual conduction gap points requiring touch-up ablation after an encircling linear ablation (R point), spontaneous reconnection points (S point), and dormant conduction points (D point) were considered as non-conduction blocking lesion points. Each ablation parameter for the non-conduction blocking lesion points was compared with the other lesion points.ResultsTwenty-one points in 16 patients were considered non-conduction blocking lesions. Ten were R, eight were S, and three were D points. The CF, ablation time, FTI, and power at the non-conduction blocking lesion points and other points were 12.0 g (7.0–21.5) and 12.0 g (9.0–16.0) (P = 0.9), 7.7 s (5.6–10.1) and 12.5 s (9.4–16.8) (P < 0.05), 103.0 g*s (62.0–174.5) and 149.0 g*s (104.0–213.0) (P < 0.05), and 30.0 W (22.5–30.0) and 30.0 W (30.0–30.0) (P = 0.06), respectively.ConclusionsShorter ablation time recorded in Visitag lead to non-conduction blocking lesion.

[1]  W. Haverkamp,et al.  Contact force mapping during catheter ablation for atrial fibrillation: procedural data and one-year follow-up , 2014, Archives of medical science : AMS.

[2]  J. le Polain de Waroux,et al.  Low contact force and force–time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation , 2015, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[3]  Mark A. Wood,et al.  Histopathologic characterization of chronic radiofrequency ablation lesions for pulmonary vein isolation. , 2012, Journal of the American College of Cardiology.

[4]  M. Kimura,et al.  Comparison of lesion formation between contact force-guided and non-guided circumferential pulmonary vein isolation: a prospective, randomized study. , 2014, Heart rhythm.

[5]  Ashok J. Shah,et al.  Mechanisms of Pulmonary Vein Reconnection After Radiofrequency Ablation of Atrial Fibrillation: The Deterministic Role of Contact Force and Interlesion Distance , 2014, Journal of cardiovascular electrophysiology.

[6]  H. Lambert,et al.  Novel Contact Force Sensor Incorporated in Irrigated Radiofrequency Ablation Catheter Predicts Lesion Size and Incidence of Steam Pop and Thrombus , 2008, Circulation. Arrhythmia and electrophysiology.

[7]  Hugh Calkins,et al.  2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. , 2014, Journal of the American College of Cardiology.

[8]  S. Ernst,et al.  Recovered Pulmonary Vein Conduction as a Dominant Factor for Recurrent Atrial Tachyarrhythmias After Complete Circular Isolation of the Pulmonary Veins: Lessons From Double Lasso Technique , 2005, Circulation.

[9]  Gerhard Hindricks,et al.  2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation--developed with the special contribution of the European Heart Rhythm Association. , 2012, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[10]  Douglas L. Packer,et al.  Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial. , 2014, Journal of the American College of Cardiology.

[11]  Atul Verma,et al.  Response of Atrial Fibrillation to Pulmonary Vein Antrum Isolation Is Directly Related to Resumption and Delay of Pulmonary Vein Conduction , 2005, Circulation.

[12]  Andreas Metzner,et al.  Long-Term Results of Catheter Ablation in Paroxysmal Atrial Fibrillation: Lessons From a 5-Year Follow-Up , 2010, Circulation.

[13]  T. Kuwahara,et al.  Simultaneous isolation of superior and inferior pulmonary veins on both the left and right sides could yield better outcomes in patients with paroxysmal atrial fibrillation. , 2015, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[14]  Nadir Saoudi,et al.  The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. , 2012, Heart rhythm.

[15]  R. Cappato,et al.  Prospective Assessment of Late Conduction Recurrence Across Radiofrequency Lesions Producing Electrical Disconnection at the Pulmonary Vein Ostium in Patients With Atrial Fibrillation , 2003, Circulation.

[16]  Peter Rausch,et al.  Incidence and anatomical locations of catheter instability during circumferential pulmonary vein isolation using contact force. , 2014, International heart journal.

[17]  M. Takigawa,et al.  Patterns of pulmonary vein potential disappearance during encircling ipsilateral pulmonary vein isolation can predict recurrence of atrial fibrillation. , 2014, Circulation journal : official journal of the Japanese Circulation Society.

[18]  David Keane,et al.  2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. , 2012, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[19]  T. Kuwahara,et al.  Long-Term Follow-Up After Catheter Ablation of Paroxysmal Atrial Fibrillation: The Incidence of Recurrence and Progression of Atrial Fibrillation , 2014, Circulation. Arrhythmia and electrophysiology.

[20]  Jan Petru,et al.  Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment: Results From the EFFICAS I Study , 2013, Circulation. Arrhythmia and electrophysiology.

[21]  Wolters Kluwer,et al.  Hrs/ehra/ecas Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design: a Report of the Heart Rhythm Society (hrs) Task Force , 2022 .

[22]  Kumaraswamy Nanthakumar,et al.  Resumption of Electrical Conduction in Previously Isolated Pulmonary Veins: Rationale for a Different Strategy? , 2004, Circulation.

[23]  J Clémenty,et al.  Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. , 1998, The New England journal of medicine.