Real World Contact Force Ablation

Healthcare systems around the world have been required to adapt to deal with the coronavirus pandemic. While some countries have been able to continue working almost as normal, others have seen systems and hospitals overwhelmed. With these challenges, systems, hospitals and medical staff have had to change the way they work, often dramatically. There has been a period of introspection across society, and what seemed important before now appears irrelevant, and changes that were resisted before having now been happily accepted. With this backdrop, how has the management and treatment of patients with arrhythmias changed?

Virtual clinics and video calling have become an accepted part of the way we work now, and the resulting rise of remote and wearable diagnostics has been dramatic. The use of devices such as the Apple Watch and other wearable ECG monitors have moved considerably into the mainstream and are likely to yield an even higher number of patients requiring medical expertise and treatment. In many ways, electrophysiologists can adapt easily as we lean towards the ECG as our main diagnostic tool when physical examination is restricted. However, direct face-to-face contact is now harder to achieve, and the control of quality information to patients is as important as it ever has been.

Interventional treatment of arrhythmias, in particular AF, while a relatively mature technique still has unanswered questions. As a community we have often focused on the underlying mechanism or trying to understand different forms of signal analysis. While process improvements were discussed, they were rarely the primary focus. In the current situation, with more limited access and time, the way in which we treat patients is much more important. Having patients in hospital for the least amount of time possible is now a priority. This has a number of important implications in the management of patients with AF. Whereas trial endpoints of mortality and stroke reduction were seen as a gold standard, perhaps more emphasis should be placed on endpoints such as reduction in hospital admissions and outpatient visits.

Day-case AF ablation has been the standard in many hospital units for a number of years, regardless of what technology has been employed. However, this has been resisted in many healthcare systems with both medical and financial reasons often cited. Now, it seems inevitable that day-case AF ablation will become the standard of care.

What other parts of the process can yield benefits by minimising the total time of the procedure? Single-shot devices are attractive, but standard point-by-point radiofrequency ablation has become much quicker, due to the standardisation of lesions, and a greater acceptance of high-power, short duration delivery. Again, this has been used in a number of labs for many years successfully, yet perhaps has not gained the respect and uptake that it should have done.

Standardisation of the process, tools that allow quicker lesion delivery, (including very high-power delivery) and electroporation will make AF ablation a shorter procedure and is likely to improve success rates. With this, will it be time to offer AF ablation sooner in a patient's journey, rather than waiting for medication failure, or repeated cardioversions? There will always be options for individual patients, but will the standard become interventional first rather than medication?

The website content and design has recently been updated and will allow for easier navigation. More content is being developed looking specifically at how we can improve the care of patients with arrhythmias in this new environment, not just maintain previous standards. Hopefully, we shall all be able to look back and find that the "new normal" has actually led to practice improvements.

 

Dr Matt Wright

Supported by Biosense Webster

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Section advisor

Consultant Cardiologist and Electrophysiologist, Guy's and St Thomas' Hospital, London, UK

The content on this site is for information purposes only and is not a substitute for professional medical advice. The views and opinions expressed in the content on this site does not necessarily reflect or represent the views and opinions of Radcliffe Cardiology or Biosense Webster*.

Featured Articles Article icon

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Different tissue thermodynamics between the 40 W and 20 W radiofrequency power settings under the same ablation index/lesion size index

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Lesion Index Titration Using Contact-Force Technology Enables Safe and Effective Radiofrequency Lesion Creation at the Root of the Aorta and Pulmonary Artery

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How is Contact Force implemented in routine clinical practice? Results from a French National and Monaco Survey

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SmartTouch™ – The Emerging Role Of Contact Force Technology In Complex Catheter Ablation

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Increasing The Single-Procedure Success Rate Of Pulmonary Vein Isolation

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Evaluation of a Strategy Aiming to Enclose the Pulmonary Veins With Contiguous and Optimized Radiofrequency Lesions in Paroxysmal Atrial Fibrillation: A Pilot Study

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Life-Threatening Complications of Atrial Fibrillation Ablation: 16-Year Experience in a Large Prospective Tertiary Care Cohort

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Review Of The Safety And Effectiveness Of The THERMOCOOL SMARTTOUCH® SF Catheter Evaluated For Treating Symptomatic PersistenT AF

Wide Area Circumferential Ablation With Contact Force Versus Cryoballoon Ablation

ClinicalTrials.gov, NCT03564925

Safety and Effectiveness of TactiCath™ Contact Force, Sensor Enabled™ (TactiCath SE) Catheter for Ablation of Drug Refractory, Symptomatic, Persistent Atrial Fibrillation

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THERMOCOOL SMARTTOUCH®SF Catheters With Ablation Index Study

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Evaluation of QDOT MICRO™ Catheter for Pulmonary Vein Isolation in Subjects With Paroxysmal Atrial Fibrillation

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Comparison of Contact-force Monitoring Irrigated Tip Catheter and Mesh-like Irrigated Tip Catheter in Atrial Fibrillation Ablation: Prospective Randomized Trial

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Registry for Real-world Experience of Catheter Ablation for Symptomatic Paroxysmal Atrial Fibrillation

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Evaluation of Ablation Index and VISITAG™ (ABI-173)

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Pulsed Field Ablation to Irreversibly Electroporate Tissue and Treat AF

ClinicalTrials.gov, NCT04198701

PVI Alone Versus Additional Low-Voltage Substrate Modification During SR Guiding By Contact-Force Catheter In Older Patients With Paroxysmal AF

ClinicalTrials.gov, NCT03462628

Contact-Force-Sensing-Based Radiofrequency Catheter Ablation in Paroxysmal Supraventricular Tachycardias

ClinicalTrials.gov, NCT04078685

Randomised Prospective Trial Comparing Contact Force and Non-contact Force Guided Catheter Ablation for Cavotricuspid Isthmus Dependent Atrial Flutter

ClinicalTrials.gov, NCT02825498

CardioFocus vs. Contact Force Guided Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation

ClinicalTrials.gov, NCT03056222