Contact Force-Guided Ablation Reduced Poor Contact Segments and Improved Acute Reconnection in Patients with Atrial Fibrillation

Abstract

Background: There is a paucity of information regarding whether contact force (CF)-guided ablation improves the outcomes of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) by achieving more optimal contact. We sought to assess whether real time CF-guided ablation has an impact on ablation parameters and acute pulmonary vein reconnection (PVR).

Methods: Left or right PVs were randomized to either CF-guided or blinded groups, and the order of CF blindness: CF-guided left PV/CF-blinded right PV, CF-blinded left PV/CF-guided right PV, CF-guided right PV/CF-blinded left PV, and CF-blinded right PV/CF-guided left PV groups. We compared CF parameters and acute PVR between segments ablated by CF-guided and CF-blinded strategies.

Results: Sixty patients with drug refractory symptomatic AF were included (paroxysmal AF 73%). CF-guided segments did not show significant differences in CF parameters compared to CF-blinded segments. However, CF-guided segments showed fewer segments with mean CF value <5 g than CF-blinded segments (4.3% vs. 12.4%, p<0.001). Forty-two patients showed acute PVR in 92 segments (8.5%). CF-guided PV segments showed lower acute PVR rate than CF-blinded segments (5.9% vs. 11.1%, p=0.011).

Conclusions: CF-guided ablation could reduce acute PVR after PVI by decreasing the number of segments with poor contact rather than increasing the mean CF during ablation. Better contact guided by CF information might help in improving the results of PVI. Further investigation will be needed to identify the association between the difference in acute reconnection and the long-term outcomes.