Contact force facilitates the achievement of an unexcitable ablation line during pulmonary vein isolation
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Contact force facilitates the achievement of an unexcitable ablation line during pulmonary vein isolation. / Schaeffer, Benjamin; Willems, Stephan; Meyer, Christian; Lüker, Jakob; Akbulak, Ruken Ö; Moser, Julia; Jularic, Mario; Eickholt, Christian; Schwarzl, Jana M; Gunawardene, Melanie; Kuklik, Pawel; Sultan, Arian; Hoffmann, Boris A; Steven, Daniel.
In: CLIN RES CARDIOL, Vol. 107, No. 8, 08.2018, p. 632-641.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Contact force facilitates the achievement of an unexcitable ablation line during pulmonary vein isolation
AU - Schaeffer, Benjamin
AU - Willems, Stephan
AU - Meyer, Christian
AU - Lüker, Jakob
AU - Akbulak, Ruken Ö
AU - Moser, Julia
AU - Jularic, Mario
AU - Eickholt, Christian
AU - Schwarzl, Jana M
AU - Gunawardene, Melanie
AU - Kuklik, Pawel
AU - Sultan, Arian
AU - Hoffmann, Boris A
AU - Steven, Daniel
PY - 2018/8
Y1 - 2018/8
N2 - 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.
AB - 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.
KW - Atrial Fibrillation/physiopathology
KW - Body Surface Potential Mapping/methods
KW - Catheter Ablation/instrumentation
KW - Equipment Design
KW - Female
KW - Follow-Up Studies
KW - Heart Conduction System/physiopathology
KW - Humans
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Pulmonary Veins/surgery
KW - Treatment Outcome
U2 - 10.1007/s00392-018-1228-0
DO - 10.1007/s00392-018-1228-0
M3 - SCORING: Journal article
C2 - 29500567
VL - 107
SP - 632
EP - 641
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 8
ER -