Three‐year outcomes and reconnection patterns after initial contact force guided pulmonary vein isolation for paroxysmal atrial fibrillation

• Published in: Journal of cardiovascular electrophysiology Vol. 28; no. 9; pp. 984 - 993
• Main Authors: Nair, Girish M., Yeo, Colin, MacDonald, Zachary, Ainslie, Mark P., Alqarawi, Wael A., Nery, Pablo B., Redpath, Calum J., Sadek, Mouhannad, Spence, Stewart, Green, Martin S., Birnie, David H.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.09.2017
• Subjects: Arrhythmia; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Body Surface Potential Mapping - methods; Cardiac arrhythmia; catheter ablation; Catheter Ablation - instrumentation; Catheters; contact‐force; Equipment Design; Female; Fibrillation; Follow-Up Studies; Heart Conduction System - diagnostic imaging; Heart Conduction System - physiopathology; Heart Conduction System - surgery; Humans; long‐term outcomes; Male; Middle Aged; paroxysmal atrial fibrillation; pulmonary vein reconnection; Pulmonary Veins - diagnostic imaging; Pulmonary Veins - surgery; Retrospective Studies; Tachycardia; Tachycardia, Paroxysmal - diagnosis; Tachycardia, Paroxysmal - physiopathology; Tachycardia, Paroxysmal - surgery; Time Factors; Treatment Outcome; Veins; contact-force; paroxysmal atrial fibrillation; catheter ablation; long-term outcomes; pulmonary vein reconnection
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.13280

Background and objective Contact force (CF) sensing is a novel technology used for catheter ablation of atrial fibrillation (AF). We compared the single procedure success of CF‐guided pulmonary vein isolation (PVI) with that of non‐CF guided PVI during a 3‐year (1,095 days) follow up period and analyzed the pattern of pulmonary vein (PV) reconnection. Methods A cohort of 167 subjects (68 CF vs. 99 non‐CF) with paroxysmal AF were included in the study. Atrial arrhythmia (AA) recurrence was defined as documented AF, atrial flutter, or atrial tachycardia lasting >30 seconds and occurring after 90 days. Results Subjects in the CF group showed a statistically nonsignificant improvement in AA free survival compared to those in the non‐CF group (66.2% vs. 51.5%; P value: 0.06). A greater propensity for reconnection was noted around the right‐sided PVs compared to left‐sided PVs related in both catheter ablation groups. For example, in the CF group 36% of right‐sided segments reconnected compared to 16% of left‐sided segments (P value <0.01). Conclusions A greater propensity for reconnection was noted around the right sided PV segments in both the CF and non‐CF groups. The explanation for this finding was related to greater catheter instability around the right sided veins. Further research is needed to explore the utility of a “real‐time” composite indicator that includes RF energy, CF and catheter stability in predicting transmural lesion formation during catheter ablation.