Atrial Fibrillation Ablation and Contact Force

Abstract

The number of patients with atrial fibrillation (AF) continues to grow in the United States. Catheter ablation is now a well-established treatment option for patients. The cornerstone for AF ablation is achievement of complete isolation of the pulmonary veins (PVs). Since the development of this procedure, much progress has been made, with improvement in long-term success and decreases in complication rates in experienced centers.

There is, however, continued opportunity to increase success rates in patients undergoing catheter ablation, as one of the known limitations has been the rate of recurrences — almostinvariably associated with electrical reconnection of the PVs. Over the past decade, a large body of clinical research has been dedicated to the development of a more efficacious tool.

It is well known that durable and transmural lesions are needed to achieve long-term success. Catheter stability and good tissue contact as well as power delivered by radiofrequency catheters are the variables needed to achieve that goal. Optimization of electrode-tissue contact can produce better lesions (with greater transmurality) while preventing complications secondary to excessive force. Up until recently, electrophysiologists were left with surrogate measures of contact, such as intracardiac electrograms and impedance changes during ablation.

The ThermoCool® SmartTouch® Catheter (ST Catheter; Biosense Webster, Inc., a Johnson & Johnson company) is the first FDA-approved catheter in the U.S. that directly measures contact force (CF) continuously, providing the data in real time and allowing electrophysiologists to have an objective measure of tissue contact. This technology has allowed us to focus on electrode-tissue contact, keeping CF at a safe yet effective level. This increases the chances that transmural and durable lesions will be created, and in turn that we will achieve better outcomes. In this article we will discuss our experience with this technology at St. Vincent’s Birmingham.

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Citation
EP Lab Digest 2014;14(6)