Persistent Atrial Fibrillation Ablation With or Without Contact Force Sensing

Abstract

Introduction: Arrhythmia recurrences remain common after ablation of persistent atrial fibrillation (PersAF). Contact force (CF)-sensing catheters have been introduced for objective assessment of contact during radiofrequency application and have been suggested to improve outcomes in ablation of paroxysmal AF, but little is known about their role in PersAF ablation. We aimed to compare the procedural profiles and outcomes of (PersAF) ablation with or without using CF-sensing catheters.

Methods: All consecutive patients undergoing first time ablation for PersAF between April 2014 and January 2015 at the Cleveland Clinic were included. Substrate modification was performed in addition to isolation of the pulmonary veins. Success rates were determined off antiarrhythmics over 1 year of follow-up.

Results: The study included 174 patients (77 CF and 97 non-CF). Ablation with CF-sensing catheters resulted in shorter procedures (median 204 vs. 216 minutes, P = 0.04) and shorter fluoroscopy time (36 vs. 48 minutes, P = 0.0005), without statistical difference in radiation dose (225 vs. 270 milligrays, P = 0.1). Arrhythmia recurrences were less likely to be observed in the CF-sensing group (27.6% vs. 46.4%, P = 0.01, log-rank P = 0.004). In multivariable Cox analyses, the use of CF-sensing catheters was associated with a lower risk of arrhythmia recurrence (hazard ratio 0.49, 95% confidence interval 0.27-0.85, P = 0.01).

Conclusions: Compared to non-CF sensing, the use of CF-sensing catheters for PersAF ablation is associated with shorter procedures, shorter fluoroscopy time, and reduction in arrhythmia recurrences.

Keywords: ablation; contact force; persistent atrial fibrillation.