Journal Article

Randomized comparison of contact force-guided versus conventional circumferential pulmonary vein isolation of atrial fibrillation: prevalence, characteristics, and predictors of electrical reconnections and clinical outcomes

Kentaro Ikeda, Shigeto Naito, Nobusada Funabashi, Takehito Sasaki, Kentaro Minami, Eiji Yamashita, Yosuke Nakatani, Masahiro Nakano, Shigeru Oshima, Koji Kumagai, Kohki Nakamura

2015

Overview

Purpose We prospectively investigated the differences in pulmonary vein reconnections (PVRs) and clinical outcomes between contact force (CF)-guided and conventional circumferential PV isolation (CPVI) of atrial fibrillation (AF). Methods One hundred twenty consecutive AF patients (63 ± 10 years; 88 males) undergoing an initial CPVI were randomized to ablation with a target CF of 20 g (CF group; n  = 60) or that with operators blinded to the CF information (blind group; n  = 60). Results The CF group had fewer PVRs (0.67 ± 0.91/patient vs. 1.16 ± 1.16/patient; P  = 0.007), a lower incidence of persistent PVRs (13.2 vs. 41.2 %; P  < 0.001), and a shorter procedural time for the CPVI (50 vs. 56 min; P  = 0.019) than the blind group. The mean CF was higher in the CF group than the blind group (18.0 vs. 16.1 g; P  < 0.001), with the most significant difference observed along the posterior right-sided PVs (P-RPVs) and anterior left-sided PVs (A-LPVs). In logistic regression models, the mean CF was a negative predictor of PVRs along the P-RPVs and A-LPVs in the blind group (odds ratios, 0.728 and 0.786; P  < 0.001 and 0.007), while no significant predictor was identified in the CF group or elsewhere in the blind group. In the Kaplan-Meier analysis, the arrhythmia-free survival rate at 12 months was 89.9 % in the CF group and 88.2 % in the blind group, respectively ( P  = 0.624). Conclusions CF-guided CPVI can reduce PVRs and the procedural time and be particularly beneficial along regions where a relatively low CF tends to be applied: the P-RPVs and A-LPVs. The comparable clinical outcomes may be due to the learning curve effect obtained by the CF-guided technique and repeated provocation of dormant PV conduction.

• Publisher: Springer Science and Business Media LLC,Springer US,Springer Nature B.V
• Subject: Atrial Fibrillation / Atrial Fibrillation - diagnosis / Atrial Fibrillation - surgery / Body Surface Potential Mapping / Body Surface Potential Mapping - methods / Cardiology / Clinical outcomes / Female / Heart Conduction System / Heart Conduction System - surgery / Humans / Male / Medicine / Medicine & Public Health / Middle Aged / Pulmonary Veins / Pulmonary Veins - surgery / Stress, Mechanical / Surgery, Computer-Assisted / Surgery, Computer-Assisted - methods / Treatment Outcome