Is Good Contact Enough for Atrial Fibrillation Ablation?

Abstract

The use of new contact force catheters has become routine in atrial fibrillation ablation with the hope that the additional contact force information will improve outcomes and reduce complications. The excitement over the use of contact force catheters stems from the fact that long-term lesion creation has not been very reliable as evidenced by reconnection of pulmonary veins shortly after isolation or atrial scar imaging using MRI. Atrial scar imaging 3 months after ablation, before contact force, has shown that as much as 50% of areas targeted for ablation did not result in long-term scar and only one-third of the pulmonary veins are completely encircled by scar despite acute isolation of pulmonary veins. Early studies with contact force have shown promising results with reduced procedure and fluoroscopy time, but the parameters that will result in stable lesions without gaps is still unknown. Some studies have shown improved outcome with the use of higher contact force, but the results are equivocal. Prior studies have also shown a positive correlation between increasing contact force and lesion size, but greater contact force is also associated with steam pops and perforations. Numerous prior works have tried addressing the issue of ideal ablation parameters such as force, power, time of ablation, impedance, and stability, but the ideal force that will result in long-term lesions while minimizing the risk of rupture is work in progress.

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Citation
JACC: Clinical Electrophysiology Volume 1, Issue 5, October 2015, Pages 432-433.