Feasibility Of Single Contact Force-Sensing Catheter For Circumferential Pulmonary Vein Isolation In The Setting Of Paroxysmal Atrial Fibrillation

Part 1:Superiority of contact force-sensing catheter for cicumferential pulmonary vein isolationBackgroud:Pulmonary vein isolation(PVI)is considered to be the cornerstone during all atrial fibrillation(AF)ablation procedures.Contact force-sensing(CFS)catheter is a novel technology that allows optimization of electrode-tissue contact to improve efficacy of AF ablation.The efficacy on the application of CFS catheter in Chinese population remains uncertain.Objective:The study aims to evaluate the efficacy of single CFS for cicumferential pulmonary vein isolation(CPVI)under real-time contact force(CF)monitoring as comparison with CFS guided by circumferential mapping catheter(CMC)blinded to CF in patients with paroxysmal atrial fibrillation(PAF).Methods and Results:A total of 120 patients with symptomatic PAF refractory to antiarrhythmic drugs were enrolled in the study and were divided into research group(N=60)and control group(N=60).The procedure CPVI was performed in all patients guided by 3-dimensional electroanatomic mapping system(CARTO).In the research group,CPVI was guided by real-time contact force monitoring using a single SmartTouch ablation catheter through once transseptal puncture,while in the control group CPVI was guided by lasso blinded to CF through twice transseptal puncture.After the ablation procedure,the electrophysiological test was performed,and then twenty minutes intervals thereafter,provocation tests were conducted with isoproterenol and adenosine triphosphate(ATP).These procedures were completed until entrance block was confirmed based on lasso.Compared with the control group,transseptal puncture time and fluoroscopy time in research group and control group were 27.3±11.2min and 32.8±12.9min respectively(P<0.05),13.6±5.2min and 16.2±7.1min,respectively(P<0.05).The average CF in bilateral pulmonary veins ablation and left side pulmonary veins ablation in research group and control group were 19.0±3.1g and 17.4±4.4g,respectively(P<0.05),17.5±3.8g and 15.4±4.7g,respectively(P<0.01).Percentage of ablation with CF<10g was significantly decreased(P<0.001)and with 10g<CF<20g was significantly increased(P<0.001)in research group as compared with control group.The average CF in superior aspect of right pulmonary veins and inferior aspect of left pulmonary veins were significantly higher in research group.There were no statistically significant differences on event rates of complications.Conclusion:Single CFS ablation catheter technique can be used to achieve CPVI with high quality and high initial isolation rates in the setting of PAF.CFS ablation catheter is expected to increase the possibility of durable PVI.Part 2:Feasibility of single CFS catheter substitutes CMC to assess PVI and ablation of residual gapsBackgroud:Based on the results in Part 1,single CFS ablation catheter technique is considered as an effective technology to improve quality and initial isolation rates in cicumferential pulmonary vein ablation in the setting of PAF.Objective:This part of study is to evaluate the clinical utility of single CFS catheter substitutes to CMC for CPVI in patients with PAF.Methods and Results:In research group,the baseline potentials were recorded in six predefined positions around each ipsilateral pair of pulmonary veins prior to ablation.Postablation potentials of these areas were compared with baseline potentials to assess PVI.Additional ablations were applied with the goal of closing the residual gaps guided by activation mapping.Another experienced operator blinded to the result of the ablation procedure used lasso to check PVI.Using single SmartTouch ablation catheter,the initial isolation rate of left pulmonary veins and right pulmonary veins were 78%and 75%,respectively.The initial isolation rate of bilateral pulmonary veins was 56.7%.Single SmartTouch ablation catheter was able to close all residual gaps guided by activation mapping.PVI as assessed with single SmartTouch ablation catheter was 100%concordant with lasso evaluation of PVIConclusions:Using gingle CFS ablation catheter is associated with high initial PVI rate.Single CFS ablation catheter with the method comparing the potentials from 6 predefined positions around each ipsilateral pulmonary vein before and after ablation and closing the residual gaps guided by activation mapping can effectively complete CPVI in absence of CMC.