Abstract 18667: Impact of Direct Contact Force Measurement on Electrical Reconnections after Circumferential Pulmonary Vein Isolation for Atrial Fibrillation Using a Contact Force-Sensing Catheter

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kohki Nakamura ◽  
Shigeto Naito ◽  
Takehito Sasaki ◽  
Kentaro Minami ◽  
Masahiro Nakano ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Contact Force ◽  
Regression Models ◽  
Force Measurement ◽  
Operating Characteristics ◽  
Multiple Regression Models ◽  
Characteristics Analysis ◽  
The Mean ◽  
The Right ◽  
Circumferential Pulmonary Vein Isolation

Purpose: To prospectively evaluate the incidence of pulmonary vein (PV) reconnections (PVRs) and identify predictors of PVRs after circumferential PV isolation (CPVI) using a contact force (CF)-sensing ablation catheter. Methods: Sixty-five patients (51-males; 61±10 years) undergoing an initial CPVI were studied. Both the right and left CPVI lines were divided into 12 segments and multiple regression models were used to predict PVRs in the four regions (each including 6 segments), the anterior and posterior RPVs and LPVs (A-RPVs, P-RPVs, A-LPVs, and P-LPVs). Each radiofrequency application was delivered with 15-30W for <30s along the P-LPVs and 30-40W for 40-60s along the others. Results: In 63 reconnected gaps, the right-PVs had more gaps in the anterior and posterior carina, while the left-PVs had more in the posterior carina than elsewhere, respectively (P<0.05). The P-RPVs and P-LPVs had significantly more gaps than the A-LPVs (17 A-RPVs, 21 P-RPVs, 6 A-LPVs, and 19 P-LPVs; P<0.05). The mean CF in the A-RPVs and P-RPVs (odds ratios (ORs), 0.916 and 0.854; P=0.014 and <0.001, respectively) and Force-Power-Time Index (FPTI) in the A-LPVs (OR, 0.99; P=0.012) were significant negative predictors of PVRs. According to the receiver operating characteristics analysis, at optimal cutoffs of mean CFs of 18g (A-RPVs) and 12g (P-RPVs), and FPTI of 36,737g.W.s (A-LPVs), the sensitivity and specificity for predicting PVRs were 81.3% and 61.9%, 71.3% and 52.9%, and 58.6% and 100%, respectively. Conclusions: The carina regions can be common sites for PVRs despite a higher CF and FPTI. An optimal CF and FPTI may be needed to prevent PVRs during an initial CPVI, especially in the RPVs and A-LPVs.

Abstract 13509: A Prospective Randomized Study on the Prevalence, Characteristics, and Predictors of Pulmonary Vein Reconnections and the Clinical Outcomes Between Contact Force-Guided and Conventional Circumferential Pulmonary Vein Isolation of Atrial Fibrillation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kohki Nakamura ◽  
Shigeto Naito ◽  
Takehito Sasaki ◽  
Kentaro Minami ◽  
Eri Goto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Outcomes ◽  
Pulmonary Vein ◽  
Contact Force ◽  
Randomized Study ◽  
Lower Percentage ◽  
Logistic Regression Models ◽  
Significant Difference ◽  
The Mean ◽  
The Right

Purpose: To prospectively investigate the differences in pulmonary vein reconnections (PVRs) and clinical outcomes between contact force (CF)-guided and conventional circumferential PV isolation (CPVI) of atrial fibrillation (AF). Methods: A total of 120 consecutive AF patients (63±10 years; 88 males) undergoing an initial CPVI were randomized to ablation with a target CF of 20g (CF-group; n=60) or that with operators blinded to the CF information (Blind-group; n=60). The right and left CPVI lines were each divided into 12 segments, and the occurrence of PVRs and CF-related parameters were evaluated in each segment. Time-dependent and adenosine-dependent PVRs were assessed twice during the procedure, just after completing the CPVI and at the end of the procedure. Results: The CF-group had significantly fewer PVRs (0.67±0.91/patient vs. 1.16±1.16/patient; P=0.007), a higher percentage of adenosine-dependent transient PVRs (60.5% vs. 28.8%; P=0.001), and lower percentage of persistent PVRs than the Blind-group. The mean CF was higher in the CF-group than in the Blind-group (Median, 18.0g vs. 16.1g; P<0.001), with the most significant difference observed along the posterior right-sided PVs (P-RPVs) and anterior left-sided PVs (A-LPVs). In multiple logistic regression models, the mean CF was a negative predictor of PVRs along the P-RPVs and A-LPVs in the Blind-group (odds ratios, 0.728 and 0.786; P<0.001 and 0.007), while no significant predictor was identified in the CF-group or along the anterior RPVs and posterior LPVs in the Blind-group. In the Kaplan-Meier analysis, the arrhythmia-free survival rate at 12 months was 91.2% in the CF-group (29.8% with antiarrhythmic drugs [AADs]) and 89.4% in the Blind-group (21.1% with AADs), respectively (P=0.596). Conclusions: CF-guided CPVI can reduce PVRs and result in a higher percentage of adenosine-dependent transient PVRs, and may be particularly beneficial along regions where a relatively low CF tends to be applied: the P-RPVs and A-LPVs. The comparable clinical outcomes may be due to (1) the learning curve effect obtained by the CF-guided technique, which improved the ablation electrode-tissue contact in the Blind-group, and (2) repeated provocation and elimination of dormant PV conduction.

P2848Electrical reconnections after pulmonary vein isolation with or without contact force-guided catheters: a comparison of the proficiency of atrial fibrillation ablation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Fujimoto ◽  
K Yodogawa ◽  
Y Iwasaki ◽  
M Hachisuka ◽  
R Mimuro ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Contact Force ◽  
High Volume ◽  
Procedure Time ◽  
Surgical Ablation ◽  
Af Ablation ◽  
Significant Difference ◽  
The Right ◽  
Posterosuperior Segment

Abstract Background Atrial fibrillation (AF) ablation is the most commonly performed catheter ablation (CA) procedure today. The 2015 ACC/AHA/HRS Advanced Training Statement reported that the success rate of AF ablation is higher in high-volume centers than in low-volume centers. We tested whether the procedure proficiency of each operator was associated with the outcome of AF ablation, and whether the ablation outcome depended on whether contact force (CF)-guided catheters were used or not, in a high-volume center. Methods We conducted a retrospective observational study including all AF patients who underwent radiofrequency CA with or without CF support since 2016 at our hospital. The patients who underwent CA at other hospitals or underwent a balloon or surgical ablation in the first session were excluded. Each ipsilateral pulmonary vein (PV) pair was divided into 8 segments. The reconnection numbers and sites of the PV segment were evaluated in the second session. Operators were divided into the experienced group (≥100 AF cases/year, at least every 3 years) and developing group (other than the experienced group), respectively. Results Among 728 patients who underwent an initial AF ablation and were followed for 510±306 days, 131 (90 males, 65±10 years) received a second ablation procedure and were analyzed. A total of 260 and 264 PV isolations (PVI) were performed by the experienced and developing group operators in the initial ablation, respectively. Compared to the experienced group, the developing group had a longer procedure time for the PVI (35±15 vs. 28±10 min, p<0.001), higher frequency of reconnections of the PVs (73% vs. 59%, p=0.01) and higher number of reconnection gaps (2.1±2.0 vs. 1.5±2.0, p=0.02), respectively. There were no significantly differences in the number of gaps between the catheters with and without CF (1.6±2.0 vs. 1.4±2.0, p=0.65) in the experienced group, however, in the developing group a smaller total number of gaps (1.5±1.6 vs. 2.4±2.1, p=0.006) and less frequency reconnection gaps of the posterosuperior segment of the right PV (10% vs. 45%, p=0.005) were seen with catheters with CF than without. There was no significant difference in the procedure time for the PVI between catheters with and without CF. Conclusions The operator proficiency may predict the outcome after AF ablation even in high-volume centers. It is preferable to perform PVI with a CF-sensing catheter for operators without adequate proficiency. Acknowledgement/Funding JSPS KAKENHI Grant Number JP18K15865

scholarly journals Comparison of lesion formation between contact force-guided and non-guided circumferential pulmonary vein isolation

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P491-P491
Author(s):  
M. Kimura ◽  
S. Sasaki ◽  
D. Horiuchi ◽  
K. Sasaki ◽  
S. Owada ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Lesion Formation ◽  
Circumferential Pulmonary Vein Isolation

scholarly journals Incidence and Anatomical Locations of Catheter Instability During Circumferential Pulmonary Vein Isolation Using Contact Force

2014 ◽  
Vol 55 (3) ◽  
pp. 249-255 ◽  
Author(s):  
Hisaki Makimoto ◽  
Roland Richard Tilz ◽  
Tina Lin ◽  
Andreas Rillig ◽  
Shibu Mathew ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Circumferential Pulmonary Vein Isolation

DENSITY, DIVERSITY, AND EFFICIENCY OF POLLINATORS OF SAINFOIN, ONOBRYCHIS VICIAEFOLIA SCOP.

1988 ◽  
Vol 120 (12) ◽  
pp. 1085-1100 ◽  
Author(s):  
K.W. Richards ◽  
P.D. Edwards
Keyword(s):  
Honey Bees ◽  
Regression Models ◽  
Bumble Bees ◽  
Independent Variables ◽  
Pollinator Species ◽  
Julian Date ◽  
Southern Alberta ◽  
Multiple Regression Models ◽  
Flower Density ◽  
The Mean

AbstractThe density and efficiency of bumble bees, honey bees, and alfalfa leafcutter bees on sainfoin, Onobrychis viciaefolia Scop., grown in southern Alberta were studied. Six species of bees were identified as pollinators, with alfalfa leafcutter bees comprising 56% of the observations, honey bees 40%, and bumble bees 4%. The density of flowers over the season can be described as curvilinear. The mean number of flowers per raceme decreased significantly over the season. The rate of foraging by pollinator species from flower to flower varied and is described by multiple regression models. Julian date, hour of day, and flower density are the independent variables. More than 90% of the bees visited three or fewer flowers per raceme when 60% of the racemes had three or more flowers available for pollination. The bees foraged on sainfoin for about 12 h per day and average bee density increased significantly with the corresponding flower density. A theoretical approach used to predict the bee populations required to pollinate varying flower densities shows that the required population of bumble bees is about two-thirds that of honey bees or alfalfa leafcutter bees. The observed populations of pollinators did not correspond well with the derived values, probably because multiple visits per flower are required for fertilization.

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