Impact of Contact Force Monitoring in Acute Pulmonary Vein Isolation Using an Anatomic Approach. A Randomized Study.

BackgroundThe impact of contact force (CF) monitoring in pulmonary vein (PV) isolation after a circumferential anatomic ablation (CAA) is unknown. We analyze the usefulness of CF monitoring in acute PV isolation and procedure parameters using a CAA. MethodsFifty patients with paroxysmal atrial fibrillation were randomized into CF-on (CF >10 grams; n = 25) or CF-off (CF blinded; n = 25) groups. We performed a first round of CAA with a ThermoCool((R)) SmartTouch((R)) catheter blinded to the LASSO((R)) catheter (Biosense Webster, Diamond Bar, CA, USA), with radiofrequency (RF) lesions tagged with the VisiTag Module. After the CAA, each PV was reviewed with the LASSO((R)) catheter recording the segments with gaps. ResultsAll the PVs were isolated with a CAA in 20 patients of the CF-on versus eight of the CF-off (P = 0.001). Of the 45 segments with gaps in the left PVs, 38 were from the CF-off (P = 0.0001). Of the eight segments with gaps in the right PVs, seven were from the CF-off (P = 0.06). The CF in the left PVs was higher in the CF-on (16.3 3.2 grams vs 10.5 +/- 4.3 grams; P = 0.0001) and similar in the right PVs (17.6 +/- 3.6 grams vs 15.2 +/- 5.3 grams; P = 0.08). All of the gaps were closed with additional RF LASSO((R))-guided touch-up. Procedure and fluoroscopy times were shorter in the CF-on (139 +/- 24 minutes vs 157 +/- 32 minutes and 20 +/- 6 minutes vs 24 +/- 7 minutes; both P = 0.039). At 12 months the AF recurrence was 84% CF-on versus 75% CF-off (log-rank P = 0.4). ConclusionsIn paroxysmal atrial fibrillation, a CAA guided by CF reduces PV gaps and shortens the procedure parameters at the expense of the left PVs.