Benefit of Contact Force Sensing Catheter Technology for Successful Left Atrial Anterior Line Formation: A Prospective Randomized Trial

Stephanie Fichtner, Reza Wakili, Konstantinos Rizas, Johannes Siebermair, Moritz F Sinner, Thomas Wiktor, Korbinian Lackermair, Franziska Schuessler, Lucia Olesch, Susanne Rainer, Stefan Kääb, Adrian Curta, Harald Kramer, Heidi L Estner, Stephanie Fichtner, Reza Wakili, Konstantinos Rizas, Johannes Siebermair, Moritz F Sinner, Thomas Wiktor, Korbinian Lackermair, Franziska Schuessler, Lucia Olesch, Susanne Rainer, Stefan Kääb, Adrian Curta, Harald Kramer, Heidi L Estner

Abstract

Introduction: The value of contact force information for ablation of LA anterior line is unknown. In a prospective randomized clinical trial, we investigated if information on contact force during left atrial (LA) anterior line ablation reduces total radiofrequency time and results in higher rates of bidirectional line block in patients undergoing pulmonary vein isolation (PVI) plus substrate modification.

Methods: We included patients with indication for pulmonary vein isolation (PVI) and additional substrate modification. For LA anterior line ablation, patients were randomized to contact force information visible (n=35) or blinded (n=37). Patients received contrast enhanced cardiac magnetic resonance imaging (cMRI) before and 3-6 months after ablation to visualize the LA anterior line. Primary endpoint was radiofrequency time to achieve bidirectional line block. Secondary endpoints were completeness of the LA anterior line on cMRI, distribution of contact force, procedural data, adverse events, and 12 months success rate.

Results: In 72 patients (64±9 years, 68% male), bidirectional LA anterior line block was achieved in 70 (97%) patients. Radiofrequency time to bidirectional block did not differ significantly across groups (contact force information visible 23±18min versus contact force information blinded 21±15min, p=0.50). The LA anterior line was discernable on cMRI in 40 patients (82%) without significant differences across randomization groups (p=0.46). No difference in applied contact force was found depending on cMRI line visibility. Twelve-month success and adverse event rates were comparable across groups.

Conclusion: Information on contact force does not significantly improve the ablation of LA anterior lines.

Clinical trial registration: The trial was registered at http://www.clinicaltrials.gov by identifier: NCT02217657.

Figures

Figure 1
Figure 1
Study flowchart. Ext CV: external cardioversion; AF: atrial fibrillation; cMRI: cardiac magnet resonance imaging; LA: left atrium; CF: contact force; PVI: pulmonary vein isolation.
Figure 2
Figure 2
The primary endpoint of time to bidirectional block of the LA anterior line did not differ between both groups.
Figure 3
Figure 3
Distribution of contact force and force time integral in different segments of the anterior line. LAA: left atrial appendage; CF: contact force; FTI: force time integral; LSPV: left superior pulmonary vein. No significant difference could be detected between groups.

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Source: PubMed

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