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
In this section
Supported by Biosense Webster


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*.
Videos
Featured Articles 
Clinical publications
Arrhythmia & Electrophysiology Review 2012; 1 :59–62
Gupta D. EP Europace 2018;20:f284–5.
Ariyarathna N, Kumar S, Thomas SP, et al. JACC Clin Electrophysiol 2018;4:707–23.
Arrhythmia & Electrophysiology Review 2017;6(2):75–9.
Conti S, Weerasooriya R, Novak P, et al. Heart Rhythm 2018;15:201–8.
Duytschaever M, O’Neill M, Martinek M. Arrhythm Electrophysiol Rev 2017;6:217–21.
Thomas S, Silvernagel J, Angel N, et al. J Cardiovasc Electrophysiol 2018;29:1143–9.
Arrhythmia & Electrophysiology Review 2017;6(4 Suppl 1):1-24
Sundaram S, Choe W, Jordan JR, et al. J Atr Fibrillation 2018;11:1760.
De PotterT, Van Herendael H, Balasubramaniam R, et al. EP Europace 2018;20:f410–8.
Münkler P, Kröger S, Liosis S, et al. Circ J 2018;82:2722–7.
Leshem E, Zilberman I, Tschabrunn CM, et al. JACC Clini Electrophysiol 2018;4:467–79.
Liu X, Palmer J. Pacing Clin Electrophysiol 2018;41:1404–11.
Wright M. JACC Clin Electrophysiol 2018;4:109–11.
Sandorfi G, Rodriguez-Mañero M, Saenen J, et al. JACC Clin Electrophysiol 2018;4:1556–65.
Taghji P, El Haddad M, Phlips T, et al. JACC Clin Electrophysiol 2018;4:99–108.
Gupta D, Chin SH. JACC Clin Electrophysiol 2018;4:1566–8.
Winkle RA, Moskovitz R, Hardwin Mead R, et al. J Interv Card Electrophysiol 2018;52:1–8.
De Pooter J, Strisciuglio T, El Haddad M, et al. JACC Clin Electrophysiol 2019;5:295–305.
Wolf M, El Haddad M, Fedida J, et al. EP Europace 2018;20:f401–9.
Rehman KA, Wazni OM, Barakat AF, et al. JACC Clin Electrophysiol 2019;5:284–91.
Phlips T, Taghji P, El Haddad M, et al. EP Europace 2018;20:f419–27.
Casella N, Gasperetti A, Gianni C, et al. Heart Rhythm 2019;16:888–95.
Whitaker J, Fish J, Harrison JL, et al. Circ Arrhythmia Electrophysiol 2018;11:e005892.
Borne RT, Sauer WH, Zipse MM, et al. JACC Clin Electrophysiol 2018;4:902–8.
Maurer T, Rottner L, Makimoto H. et al. Clin Res Cardiol 2018;107:1003–12.
Wright M, Harks E, Deladi S, et al. JACC Clin Electrophysiol 2018;4:1062–72.
Alfonso-Almazán JM, Quintanilla JG, García-Torrent MJ, et al. Circ Arrhythmia Electrophysiol 2019;12:e007080
Bun SS, Lațcu DG, Taghji P, et al. J Arrhythm 2019;35:238–43.
Begg GA, O’Neill J, Sohaib A, et al. PLoS One 2019;14:e0212903.
Vlachos K, Denis A, Takigawa M, et al. Heart Rhythm 2019;16:1341–7.
Pedrote A, Acosta J, Frutos-López M, et al. Pacing Clin Electrophysiol 2019;42:678–85.
Kawaji T, Hojo S, Kushiyama A, et al. J Cardiovasc Electrophysiol 2019;30:926–33.
Reddy VY, Grimaldi M, De Potter T, et al. JACC Clin Electrophysiol 2019;5:787–8.
Zhang X, Kuang X, Gao X, et al. Circ Arrhythmia Electrophysiol 2019;12:e007044.
Gelman D, Skanes AC, Jones DL, et al. J Cardiovasc Electrophysiol 2019;30:1652–62.
Vassallo F, Cunha C, Serpa E, et al. J Cardiovasc Electrophysiol 2019;30:1877–83.
Forkmann M, Schwab C, Edler D, et al. J Cardiovasc Electrophysiol 2019;30:1886–93.
Berte B, Ruschitzka F, Hilfiker G, et al. J Cardiovasc Electrophysiol 2019;30:2199–204.
Pambrun T, Durand C, Constantin M, et al. Circ Arrhythm Electrophysiol 2019;12:e007304.
Dhillon G, Ahsan S, Honarbakhsh S, et al. J Cardiovasc Electrophysiol 2019;30:357–65.
Bunch TJ, May HT, Bair TL, et al. Heart Rhythm 2019; epub ahead of press.
Winkle RA. J Cardiovasc Electrophysiol 2019;30:688–90.
Ejima K, Kato K, Okada A, et al. Circ Arrhythm Electrophysiol 2019;12:e007311.
Winkle RA, Mohanty S, Patrawala RA, et al. Heart Rhythm 2019;16:165–9.
Dinshaw L, Schäffer B, Akbulak Ö, et al. J Cardiovasc Electrophysiol 2019;30:679–87.
De Potter T, Hunter TD, Ming Boo L, et al. J Interv Card Electrophysiol 2019; epub ahead of press.
Andrade J, Champagne J, Dubuc M, et al. Circulation 2019;140:1779–88.
Takemoto M, Takami M, Fukuzawa K, et al. J Cardiovasc Electrophysiol 2019; epub ahead of press.
Mansour, M et al. JACC: Clinical Electrophysiology 2020 [Epub ahead of print].
Pollak, SJ et al. J Comp Eff Res 2019;8;4: 251-264.
Giehm-Reese, M et al. Int J Cardiol 2020;298: 44-51.
Chen, S et al. J Cardiovasc Electrophysiol 2019;30;12: 2724-2731.
Wolf, M et al. Heart Rhythm 2019;16;7: 1013-1020.
Andrade, JG et al. Heart Rhythm 2020 [Epub ahead of print].
Friedman, DJ et al. Heart Rhythm 2020 [Epub ahead of print].
Garrott, K et al. Heart Rhythm 2020 [Epub ahead of print].
Congress Updates
Duytschaever M, Wright M, Stabile G. Incathlab 2018.
Duytschaever M, Vijgen J, De Potter T, et al. European Heart Journal 2018;39:ehy566.P6227
Gupta D, Jadidi A, Deisenhofer I. Incathlab 2019.
J Cardiovasc Electrophysiol. 2020;31:754–796.
Editorials
Raja DC, Sanders P, Pathak RK. J Cardiovasc Electrophysiol 2019;30:2205–8.
Winkle RA. J Cardiovasc Electrophysiol 2019;30:1884–5.
Hoshiyama T, Fukushima H, Noda K, et al. Circ Arrhythm Electrophysiol 2019;12:e007320.
Ongoing trials
ClinicalTrials.gov, NCT03650556
ClinicalTrials.gov, NCT03963349
ClinicalTrials.gov, NCT03775512
ClinicalTrials.gov, NCT04264117
ClinicalTrials.gov, NCT04088071
ClinicalTrials.gov, NCT03062046
ClinicalTrials.gov, NCT04198701
ClinicalTrials.gov, NCT03462628
ClinicalTrials.gov, NCT04078685
ClinicalTrials.gov, NCT02825498
ClinicalTrials.gov, NCT03056222
ClinicalTrials.gov, NCT03564925
Review articles
Arrhythmia & Electrophysiology Review 2013;3(1):44-7
Thiyagarajah A, Kadhim K, Lau DH, et al. Circ Arrhythm Electrophysiol 2019;12:e007005.
Asad ZUA, Yousif A, Khan MS, et al. Circ Arrhythm Electrophysiol 2019;12:e007414.
Calkins H. Circulation 2019;140:1789–91.
Arrhythmia & Electrophysiology Review 2019;8(4):265–72.
Virk, SA et al. Card Electrophysiol Clin 2019;11;3: 473-479.
Chen, CF et al. Clin Cardiol 2020;43;3: 267-274.
Virk, SA et al. Europace 2019;21;2: 239-249.
Arrhythmia & Electrophysiology Review 2020;9(1):8–14.
Gupta D. EP Europace 2018;20:f284–5.
Arrhythmia & Electrophysiology Review 2012; 1 :59–62
Ariyarathna N, Kumar S, Thomas SP, et al. JACC Clin Electrophysiol 2018;4:707–23.
Conti S, Weerasooriya R, Novak P, et al. Heart Rhythm 2018;15:201–8.
Arrhythmia & Electrophysiology Review 2017;6(2):75–9.
Thomas S, Silvernagel J, Angel N, et al. J Cardiovasc Electrophysiol 2018;29:1143–9.
Duytschaever M, O’Neill M, Martinek M. Arrhythm Electrophysiol Rev 2017;6:217–21.
Sundaram S, Choe W, Jordan JR, et al. J Atr Fibrillation 2018;11:1760.
Arrhythmia & Electrophysiology Review 2017;6(4 Suppl 1):1-24
Münkler P, Kröger S, Liosis S, et al. Circ J 2018;82:2722–7.
De PotterT, Van Herendael H, Balasubramaniam R, et al. EP Europace 2018;20:f410–8.
Liu X, Palmer J. Pacing Clin Electrophysiol 2018;41:1404–11.
Leshem E, Zilberman I, Tschabrunn CM, et al. JACC Clini Electrophysiol 2018;4:467–79.
Sandorfi G, Rodriguez-Mañero M, Saenen J, et al. JACC Clin Electrophysiol 2018;4:1556–65.
Wright M. JACC Clin Electrophysiol 2018;4:109–11.
Gupta D, Chin SH. JACC Clin Electrophysiol 2018;4:1566–8.
Taghji P, El Haddad M, Phlips T, et al. JACC Clin Electrophysiol 2018;4:99–108.
De Pooter J, Strisciuglio T, El Haddad M, et al. JACC Clin Electrophysiol 2019;5:295–305.
Winkle RA, Moskovitz R, Hardwin Mead R, et al. J Interv Card Electrophysiol 2018;52:1–8.
Rehman KA, Wazni OM, Barakat AF, et al. JACC Clin Electrophysiol 2019;5:284–91.
Wolf M, El Haddad M, Fedida J, et al. EP Europace 2018;20:f401–9.
Casella N, Gasperetti A, Gianni C, et al. Heart Rhythm 2019;16:888–95.
Phlips T, Taghji P, El Haddad M, et al. EP Europace 2018;20:f419–27.
Whitaker J, Fish J, Harrison JL, et al. Circ Arrhythmia Electrophysiol 2018;11:e005892.
Borne RT, Sauer WH, Zipse MM, et al. JACC Clin Electrophysiol 2018;4:902–8.
Maurer T, Rottner L, Makimoto H. et al. Clin Res Cardiol 2018;107:1003–12.
Wright M, Harks E, Deladi S, et al. JACC Clin Electrophysiol 2018;4:1062–72.
Alfonso-Almazán JM, Quintanilla JG, García-Torrent MJ, et al. Circ Arrhythmia Electrophysiol 2019;12:e007080
Bun SS, Lațcu DG, Taghji P, et al. J Arrhythm 2019;35:238–43.
Begg GA, O’Neill J, Sohaib A, et al. PLoS One 2019;14:e0212903.
Vlachos K, Denis A, Takigawa M, et al. Heart Rhythm 2019;16:1341–7.
Pedrote A, Acosta J, Frutos-López M, et al. Pacing Clin Electrophysiol 2019;42:678–85.
Kawaji T, Hojo S, Kushiyama A, et al. J Cardiovasc Electrophysiol 2019;30:926–33.
Reddy VY, Grimaldi M, De Potter T, et al. JACC Clin Electrophysiol 2019;5:787–8.
Zhang X, Kuang X, Gao X, et al. Circ Arrhythmia Electrophysiol 2019;12:e007044.
Gelman D, Skanes AC, Jones DL, et al. J Cardiovasc Electrophysiol 2019;30:1652–62.
Vassallo F, Cunha C, Serpa E, et al. J Cardiovasc Electrophysiol 2019;30:1877–83.
Forkmann M, Schwab C, Edler D, et al. J Cardiovasc Electrophysiol 2019;30:1886–93.
Berte B, Ruschitzka F, Hilfiker G, et al. J Cardiovasc Electrophysiol 2019;30:2199–204.
Dhillon G, Ahsan S, Honarbakhsh S, et al. J Cardiovasc Electrophysiol 2019;30:357–65.
Pambrun T, Durand C, Constantin M, et al. Circ Arrhythm Electrophysiol 2019;12:e007304.
Winkle RA. J Cardiovasc Electrophysiol 2019;30:688–90.
Bunch TJ, May HT, Bair TL, et al. Heart Rhythm 2019; epub ahead of press.
Winkle RA, Mohanty S, Patrawala RA, et al. Heart Rhythm 2019;16:165–9.
Ejima K, Kato K, Okada A, et al. Circ Arrhythm Electrophysiol 2019;12:e007311.
Dinshaw L, Schäffer B, Akbulak Ö, et al. J Cardiovasc Electrophysiol 2019;30:679–87.
De Potter T, Hunter TD, Ming Boo L, et al. J Interv Card Electrophysiol 2019; epub ahead of press.
Andrade J, Champagne J, Dubuc M, et al. Circulation 2019;140:1779–88.
Takemoto M, Takami M, Fukuzawa K, et al. J Cardiovasc Electrophysiol 2019; epub ahead of press.
Mansour, M et al. JACC: Clinical Electrophysiology 2020 [Epub ahead of print].
Pollak, SJ et al. J Comp Eff Res 2019;8;4: 251-264.
Giehm-Reese, M et al. Int J Cardiol 2020;298: 44-51.
Chen, S et al. J Cardiovasc Electrophysiol 2019;30;12: 2724-2731.
Wolf, M et al. Heart Rhythm 2019;16;7: 1013-1020.
Andrade, JG et al. Heart Rhythm 2020 [Epub ahead of print].
Friedman, DJ et al. Heart Rhythm 2020 [Epub ahead of print].
Garrott, K et al. Heart Rhythm 2020 [Epub ahead of print].
Duytschaever M, Wright M, Stabile G. Incathlab 2018.
Duytschaever M, Vijgen J, De Potter T, et al. European Heart Journal 2018;39:ehy566.P6227
Gupta D, Jadidi A, Deisenhofer I. Incathlab 2019.
J Cardiovasc Electrophysiol. 2020;31:754–796.
Raja DC, Sanders P, Pathak RK. J Cardiovasc Electrophysiol 2019;30:2205–8.
Winkle RA. J Cardiovasc Electrophysiol 2019;30:1884–5.
Hoshiyama T, Fukushima H, Noda K, et al. Circ Arrhythm Electrophysiol 2019;12:e007320.
ClinicalTrials.gov, NCT03650556
ClinicalTrials.gov, NCT03963349
ClinicalTrials.gov, NCT03775512
ClinicalTrials.gov, NCT04264117
ClinicalTrials.gov, NCT04088071
ClinicalTrials.gov, NCT03062046
ClinicalTrials.gov, NCT04198701
ClinicalTrials.gov, NCT03462628
ClinicalTrials.gov, NCT04078685
ClinicalTrials.gov, NCT02825498
ClinicalTrials.gov, NCT03056222
ClinicalTrials.gov, NCT03564925
Arrhythmia & Electrophysiology Review 2013;3(1):44-7
Thiyagarajah A, Kadhim K, Lau DH, et al. Circ Arrhythm Electrophysiol 2019;12:e007005.
Asad ZUA, Yousif A, Khan MS, et al. Circ Arrhythm Electrophysiol 2019;12:e007414.
Calkins H. Circulation 2019;140:1789–91.
Arrhythmia & Electrophysiology Review 2019;8(4):265–72.
Virk, SA et al. Card Electrophysiol Clin 2019;11;3: 473-479.
Chen, CF et al. Clin Cardiol 2020;43;3: 267-274.
Virk, SA et al. Europace 2019;21;2: 239-249.
Arrhythmia & Electrophysiology Review 2020;9(1):8–14.
Macle, L et al. BMJ Open 2019;9;6: e023775