Use of electrical coupling information in AF catheter ablation: a prospective randomized pilot study.
BACKGROUND
Catheter contact is important for radiofrequency (RF) ablation. Local electrical catheter-to-tissue coupling has been described as a tool to objectively measure contact.


OBJECTIVE
We hypothesized that pulmonary vein isolation (PVI) ablation using electrical coupling information (ECI) would yield higher rates of PVI than an approach without ECI.


METHODS
Forty patients with atrial fibrillation were prospectively included. In each patient, 1 pair of pulmonary veins (PVs) was randomly chosen to be encircled with ECI available while the other pair was encircled without use of ECI.


RESULTS
The rate of PVI was significantly higher in PVs encircled with ECI available (58% vs 30%; P = .024). PV encircling with coupling resulted in slightly longer procedure (26.5 [interquartile range {IQR} 22-32.5] vs 23.5 [IQR 19-26.5] minutes; P = .019), fluoroscopy (9.0 [IQR 6-12] vs 6.9 [IQR 4-8.6] minutes; P = .011), and RF (20.0 [IQR 16.5-23.5] vs 17.3 [IQR 15.1-20.6] minutes; P = .015) times. For nonisolated PVs, the coupling group had significantly fewer gaps (3.0 [IQR 1.8-7] vs 6.0 [IQR 4-11]; P = 0.021) and gap mapping/closure needed shorter procedure (9.0 [IQR 4-16] vs 13.0 [IQR 11-21] minutes; P = .04), fluoroscopy (3.9 [IQR 2-7.1] vs 6.0 [IQR 4.6-7.9] minutes; P = .038), and RF (1.9 [IQR 0.9-5] vs 5.2 [IQR 3.3-8.6] minutes; P = .016) times.


CONCLUSIONS
The use of ECI improved lesion deployment measured as higher rates of PVI after anatomical encircling. For nonisolated PVs, fewer gaps and faster gap closure were found using ECI.
Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany. gasparthomas@hotmail.com
Thomas
T
Gaspar
Haris
H
Sih
Gerhard
G
Hindricks
Charlotte
C
Eitel
Philipp
P
Sommer
Simon
S
Kircher
Sascha
S
Rolf
Arash
A
Arya
Liane
L
Teplitsky
Christopher
C
Piorkowski
D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D015716:Electrocardiography, Ambulatory / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016011:Normal Distribution; D010865:Pilot Projects; D011182:Postoperative Care; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult