The symbiosis of contact force catheter use for hybrid ablation for atrial fibrillation

ObjectivesContact force-sensing catheters allow real-time catheter-tissue contact force monitoring during atrial fibrillation. These catheters were rapidly adopted into clinical practice following market introduction in 2014, but concerns have been raised regarding collateral damage such as esophageal injury. We sought to examine whether the introduction of force-sensing catheters was associated with a change in short-term and intermediate-term acute care use, complications and mortality following atrial fibrillation ablation.DesignRetrospective cohort analysis. We used inverse probability treatment weight matching to account for the differences in baseline characteristics between groups.SettingWe examined patients included in the OptumLabs Data Warehouse who underwent ablation for atrial fibrillation before (2011–2013) and after (2015–2017) the market introduction of contact force-sensing catheters.Main outcome measuresWe examined 30-day and 90-day rates of all-cause acute care use, including hospitalizations and emergency department visits, as well as death and hospitalization for catheter-related complications, including atrioesophageal fistula, pericarditis, cardiac tamponade/perforation and stroke/transient ischemic attack.ResultsOur sample included 3470 and 5772 patients who underwent atrial fibrillation (AF) ablation before and after market introduction of contact force-sensing catheters, respectively. Complication rates were low and did not differ between the two periods (p>0.10 for each outcome). The 30-day and 90-day mortality was 0.1% and 0.3%, respectively after market introduction and unchanged from prior to 2014. The 90-day rates of all-cause acute care use decreased, from 27.0% in 2011–2013 to 23.9% in 2015–2017 (p<0.001).ConclusionsAF ablation-related catheter complications and mortality are low and there has been no significant change following the introduction of force-sensing catheters.

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Targeting Bachmann’s bundle in hybrid ablation for long-standing persistent atrial fibrillation: a proof of concept study

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-00971-7 ◽

2021 ◽

Author(s):

Giuseppe De Martino ◽

Giuseppe Nasso ◽

Alessio Gasperetti ◽

Marco Moscarelli ◽

Carmine Mancusi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Persistent Atrial Fibrillation ◽

Proof Of Concept ◽

Concept Study ◽

Hybrid Ablation ◽

Bachmann’S Bundle

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B-PO02-115 MINIMALIST APPROACH TO HYBRID ABLATION FOR ATRIAL FIBRILLATION: FEASIBILITY & EFFICACY OF UNILATERAL EPICARDIAL ACCESS

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.369 ◽

2021 ◽

Vol 18 (8) ◽

pp. S144

Author(s):

Terrence Pong ◽

Rajan L. Shah ◽

Cody Carlton ◽

Angeline Truong ◽

Kevin Cyr ◽

...

Keyword(s):

Atrial Fibrillation ◽

Minimalist Approach ◽

Hybrid Ablation ◽

Epicardial Access

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Outcome of contact force-guided radiofrequency catheter ablation or second generation cryoballoon ablation for paroxysmal atrial fibrillation: propensity score matched analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.0571 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Ukita ◽

A Kawamura ◽

H Nakamura ◽

K Yasumoto ◽

M Tsuda ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Propensity Score ◽

Contact Force ◽

Paroxysmal Atrial Fibrillation ◽

Radiofrequency Catheter Ablation ◽

Second Generation ◽

Late Recurrence ◽

Cryoballoon Ablation ◽

Atrial Tachyarrhythmia

Abstract Background Little has been reported on the outcome of contact force (CF)-guided radiofrequency catheter ablation (RFCA) and second generation cryoballoon ablation (CBA). Purpose The purpose of this study was to compare the outcome of CF-guided RFCA and second generation CBA for paroxysmal atrial fibrillation (PAF). Methods We enrolled the consecutive 364 patients with PAF who underwent initial ablation between September 2014 and July 2018 in our hospital. We compared the late recurrence of atrial tachyarrhythmia more than three months after ablation between RFCA group and CBA group. All RFCA procedures were performed using CF-sensing catheter and all CBA procedures were performed using second generation CB. Results There were significant differences in background characteristics: chronic kidney disease, serum brain natriuretic peptide level, and left ventricular ejection fraction. After propensity score matched analysis (Table), atrial tachyarrhythmia free survival was significantly higher in CBA group than in RFCA group (Figure). Conclusions Second generation CBA showed a significantly lower late recurrence rate compared to CF-guided RFCA. Kaplan-Meier Curve Funding Acknowledgement Type of funding source: None

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Real-time local impedance monitoring to assess tissue lesion during pulmonary vein isolation: a new tool for AF ablation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0562 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Di Cori ◽

L Segreti ◽

G Zucchelli ◽

S Viani ◽

F Tarasco ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Contact Force ◽

Vascular Complications ◽

Lesion Formation ◽

Tissue Impedance ◽

Af Ablation ◽

Group 2 ◽

Group 1

Abstract Background Contact force catheter ablation is the gold standard for treatment of atrial fibrillation (AF). Local tissue impedance (LI) evaluation has been recently studied to evaluate lesion formation during radiofrequency ablation. Purpose Aim of the study was to assess the outcomes of an irrigated catether with LI alghorithm compared to contact force (CF)-sensing catheters in the treatment of symptomatic AF. Methods A prospective, single-center, nonrandomized study was conducted, to compare outcomes between CF-AF ablation (Group 1) and LI-AF ablation (Group 2). For Group 1 ablation was performed using the Carto 3© System with the SmartTouch SF catheter and, as ablation target, an ablation index value of 500 anterior and 400 posterior. For Group 2, ablation was performed using the Rhythmia™ System with novel ablation catheter with a dedicated algorithm (DirectSense) used to measure LI at the distal electrode of this catheter. An absolute impedance drop greater than 20Ω was used at each targeted. According to the Close Protocol, ablation included a point by point pulmonary vein isolation (PVI) with an Inter-lesion space ≤5 mm in both Groups. Procedural endpoint was PVI, with confirmed bidirectional block. Results A total of 116 patients were enrolled, 59 patients in Group 1 (CF) and 57 in Group 2 (LI), 65 (63%) with a paroxismal AF and 36 (37%) with a persistent AF. Baseline patients features were not different between groups (P=ns). LI-Group showed a comparable procedural time (180±89 vs 180±56, P=0.59) but with a longer fluoroscopy time (20±12 vs 13±9 min, P=0.002). Wide antral isolation was more often observed in CF-Group (95% vs 80%, P=0.022), while LI-Group 2 required frequently additional right or left carina ablation (28% vs 14%, P=0.013). The mean LI was 106±14Ω prior to ablation and 92.5±11Ω after ablation (mean LI drop of 13.5±8Ω) during a median RF time of 26 [19–34] sec for each ablation spot. No steam pops or complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated in all study patients. Regarding safety, only minor vascular complications were observed (5%), without differences between groups (p=0.97). During follow up, 9-month freedom from atrial fibrillation/atrial flutter/atrial tachycardia recurrence was 86% in Group 1 and 75% in Group 2 (P=0.2). Conclusions An LI-guided PV ablation strategy seems to be safe and effective, with acute and mid-term outcomes comparable to the current contact force strategy. LI monitoring could be a promising complementary parameter to evaluate not only wall contact but also lesion formation during power delivery. Procedural Outcomes Funding Acknowledgement Type of funding source: None

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