Contact force-controlled zero-fluoroscopy catheter ablation of right-sided and left atrial arrhythmia substrates.
BACKGROUND
Conventional catheter ablation of cardiac arrhythmias is associated with radiation risks for patients and laboratory personnel. However, nonfluoroscopic catheter guidance may increase the risk for inadvertent cardiac injury. A novel radiofrequency ablation catheter capable of real-time tissue-tip contact force measurements may compensate for nonfluoroscopic safety issues.


OBJECTIVE
To investigate the feasibility of contact force-controlled zero-fluoroscopy catheter ablation.


METHODS
In 30 patients (including 12 pediatric patients), zero-fluoroscopy catheter ablation of right-sided (right atrium, n = 20; right ventricle, n = 2) and left atrial (n = 8) arrhythmias was attempted. Inclusion criteria were symptomatic suspected atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal right atrial and ventricular arrhythmias, and lone atrial fibrillation. A novel irrigated-tip catheter with an integrated contact force sensor was used for nonfluoroscopic 3-dimensional electroanatomical mapping and radiofrequency ablation. Transseptal access was gained under transesophageal guidance for ablation of left-sided arrhythmias.


RESULTS
Procedural success without fluoroscopy was achieved in 29 of the 30 patients (97%). In 1 patient, endocardial nonfluoroscopic ablation failed because of an epicardial accessory pathway within a coronary sinus aneurysm. Mean total contact force and amplitude of force undulations were kept below 50 g during mapping and below 40 g during ablation to prevent contact force peaks (>100 g). Apart from a transient second-degree type I atrioventricular block, no complications occurred. The mean procedure time was 2.8 ± 0.9 hours. There were no arrhythmia recurrences during a mean follow-up of 6.2 ± 4.2 months.


CONCLUSIONS
Contact force-controlled zero-fluoroscopy catheter ablation is generally feasible in right-sided and left atrial cardiac arrhythmias.
Eberhard-Karls-Universität Tübingen, Tübingen, Germany. gunter.kerst@med.uni-tuebingen.de
Gunter
G
Kerst
Hans-Jörg
HJ
Weig
Slawomir
S
Weretka
Peter
P
Seizer
Michael
M
Hofbeck
Meinrad
M
Gawaz
Jürgen
J
Schreieck
D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D004562:Electrocardiography; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000601:surgery*; D013617:Tachycardia, Supraventricular / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult