Relationship Between Contact Force Sensing Technology and Medium-Term Outcome of Atrial Fibrillation Ablation: A Multicenter Study of 600 Patients

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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Use of contact force sensing technology during radiofrequency ablation reduces recurrence of atrial fibrillation: A systematic review and meta-analysis

Heart Rhythm ◽

10.1016/j.hrthm.2015.06.026 ◽

2015 ◽

Vol 12 (9) ◽

pp. 1990-1996 ◽

Cited By ~ 50

Author(s):

Muhammad R. Afzal ◽

Jawaria Chatta ◽

Anweshan Samanta ◽

Salman Waheed ◽

Morteza Mahmoudi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Radiofrequency Ablation ◽

Contact Force ◽

Meta Analysis ◽

Force Sensing ◽

Sensing Technology

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Abstract 14616: Tailored Low Voltage Zones Ablation Using Contact Force Sensing Technology in Patients With Persistent Atrial Fibrillation (TWEET-AF): A Pilot Study

Circulation ◽

10.1161/circ.142.suppl_3.14616 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Gabriele DAmbrosio ◽

Santi Raffa ◽

Silvio Romano ◽

Markus Frommhold ◽

Obaida Alothman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Contact Force ◽

Low Voltage ◽

Volume Index ◽

Success Rates ◽

Term Outcome ◽

Long Term Outcome ◽

Substrate Modification ◽

Sensing Technology ◽

Linear Ablation

Introduction: Although pulmonary vein (PV) isolation (PVI) is very effective in paroxysmal atrial fibrillation (AF), in patients (pts) with persistent AF, PVI often is not sufficient. Many studies suggested that low voltage zones (LVZs) outside of the PV might be involved in the complex mechanisms perpetuating AF. However ablation strategies involving substrate modification (SM) did not show additional benefits in persistent AF pts. Those studies were performed before the introduction of contact force technology, and the most likely explanation for these results could be the inability to achieve effective transmural lesions and continuous linear ablation. Hypothesis: We hypothesized that the use of contact force technology would improve ablation efficacy. Therefore, we analyzed the long-term outcome after two different ablation strategies in pts with persistent AF depending on whether there was evidence of LVZs in the left atrium or not. Methods: The presence of LVZs were defined as sites of >3 adjacent low-voltage points <0.5 mV during electrophysiology study. Depending on the location of the LVZ, linear ablation was performed. Catheter ablation was performed using TactiCath™ or SmartTouch™ ablation catheters aiming at contact values ≥10g <20g and FTI >400g/s. Ablation was performed in a temperature-controlled fashion with energy of 30W except at the posterior wall (20-25W). Results: 121 consecutive pts with persistent AF (46 female, median age 66 [59-72] years, mean duration of AF 16 [7-73] months, CT derived LA volume index 66 [56-75]ml/m2) were included: pts without LVZs underwent PVI alone (n = 74), in pts with LVZs, PVI + SM (n = 47) was performed (mitral Isthmus line in 2, supero-septal line in 39, and roof line in 47; bidirectional block was achieved in 100%, 97%, and 100%, respectively). After a median follow-up of 13 [6-21] months, 86% of pts without and 78% with substrate were in sinus rhythm, mainly without antiarrhythmic drugs (89% PVI only, 84% PVI + SM). Conclusions: In patients with persistent AF without LVZs, PVI alone leads to excellent 2-year freedom from AF. In pts with LVZs, additional substrate modification with CF sensing technology is associated with improved success rates compared to previous studies.

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P371Impact of contact force sensing ablation catheter on atrial fibrillation ablation procedure

EP Europace ◽

10.1093/ehjci/eux141.097 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii70-iii70

Author(s):

C. Arantes ◽

N. Cortez-Dias ◽

J. Agostinho ◽

IS. Goncalves ◽

G. Lima Da Silva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Contact Force ◽

Atrial Fibrillation Ablation ◽

Force Sensing ◽

Ablation Catheter ◽

Ablation Procedure

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Long-term safety and effectiveness of paroxysmal atrial fibrillation ablation using a porous tip contact force-sensing catheter from the SMART SF trial

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-020-00780-4 ◽

2020 ◽

Author(s):

Andrea Natale ◽

George Monir ◽

Anshul M. Patel ◽

Robert S. Fishel ◽

Francis E. Marchlinski ◽

...

Keyword(s):

Atrial Fibrillation ◽

Contact Force ◽

Paroxysmal Atrial Fibrillation ◽

Atrial Fibrillation Ablation ◽

Force Sensing

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28 A meta-analysis on the impact of contact force sensing catheters on outcomes in atrial fibrillation ablation: a focus on study design

10.1136/heartjnl-2019-bcs.27 ◽

2019 ◽

Author(s):

Amit Kaura ◽

Nicholas Sunderland ◽

Francis Murgatroyd ◽

Para Dhillon ◽

Paul Scott

Keyword(s):

Atrial Fibrillation ◽

Contact Force ◽

Study Design ◽

Meta Analysis ◽

Atrial Fibrillation Ablation ◽

Force Sensing ◽

The Impact

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P1383Procedural differences during de novo paroxysmal atrial fibrillation ablation with a contact force-sensing ablation catheter between Europe and U.S

EP Europace ◽

10.1093/europace/euaa162.005 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

H Ramanna ◽

J L Lloret ◽

F Zahwe ◽

C Porterfield ◽

S Trines ◽

...

Keyword(s):

Atrial Fibrillation ◽

Contact Force ◽

Paroxysmal Atrial Fibrillation ◽

De Novo ◽

Magnetic Sensor ◽

Atrial Fibrillation Ablation ◽

Force Sensing ◽

Ablation Catheter ◽

Clinical Practices ◽

Procedural Time

Abstract Background Although pulmonary vein isolation (PVI) is considered the standard approach of atrial fibrillation ablation worldwide, procedural practice during the ablation varies by geographical region. Using the same magnetic sensor enabled contact force-sensing ablation catheter for the treatment of de novo paroxysmal atrial fibrillation, a comparison of procedural detail between Europe and U.S operators can provide insights into geographic specific clinical practices. Purpose To characterize and compare procedural differences during paroxysmal atrial fibrillation ablation performed with a magnetic sensor enabled contact force-sensing catheter across European and U.S. centers. Methods Procedural data were prospectively collected in clinical cases performed with a new magnetic sensor enabled, contact force ablation catheter within the first 6 months of use at participating centers in Europe and the U.S. Procedure time, PVI time, PVI confirmation method, fluoroscopy usage and lesion delivery parameters were analyzed based on geographies. Results A total of 131 cases across 35 centers in 11 European countries, and 95 cases across 26 U.S. centers were analyzed. Target geometry was created with the ablation catheter in 94 out of 131 (71.8%) European cases, while only 5 out of 95 U.S. cases (5.3%) reported the use of the ablation catheter for model creation. Although a steerable sheath (64.1% and 67.3%) was commonly used with the ablation catheter in both geographies, difference in the utilization of bidirectional contact force catheter (52.7% and 90.5%) and the automated lesion marking module (76.3% and 81.1%) were observed in European and U.S. cases, respectively. The use of adenosine or isoproterenol to confirm PVI was reported in 25% and 64% of the European and U.S. cases. Average waiting periods were 18.2 minutes and 26.5 minutes from reported European and U.S. cases. Total procedural time, mapping time, and fluoroscopy time were similar between European and U.S. cases. (Table). First pass PVI were 66.4% and 72.6% for European and U.S. cases, respectively. Conclusion Total procedural time and RF time were similar between European and U.S. cases during de novo paroxysmal atrial fibrillation ablation using the same ablation catheter. Differences in workflow including the use of a mapping catheter for geometry creation and waiting period were observed between the two geographies. Summary of procedural details De novo PAF N Procedural time(min) Mapping time (min) PVI time (min) Total RF time (min) Fluoro time( min) Europe 131 144.0 ± 56.9 16.6 ± 17.1 69.8 ± 35.0 33.2 ± 15.6 11.6 ± 10.1 U.S. 95 137.6 ± 64.8 18.1 ± 23.5 58.8 ± 31.5 32.3 ± 22.2 12.0 ± 15.8

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