title: Mechanisms of pulmonary vein reconnection after radiofrequency ablation of atrial fibrillation: the deterministic role of contact force and interlesion distance.
abstract: BACKGROUND
  Pulmonary vein reconnection (PVR) is an important cause of AF recurrence after ablation. With the advent of force sensing catheters, catheter-tissue contact can be determined quantitatively. Since contact force (CF) plays a major role in determining the characteristics of RF lesion, we prospectively assessed the mechanisms of PVR with regard to catheter-contact and lesion distances in patients undergoing AF ablation.
  
  
  RESULTS
  Forty symptomatic AF patients underwent wide circumferential PV isolation (PVI) with SmartTouch™ CF catheter. The exact locations of acute PVI and spontaneous or adenosine-provoked PVR were annotated on CARTO. One thousand nine hundred and twenty-six RF lesions isolated 153 PVs. PVR occurred in 35 (23%) PVs: 22 (63%) adenosine-provoked and 13 (37%) spontaneous. CF was significantly lower at PVR versus PVI sites for RF lesions within 6 mm from these sites: mean CF 5 versus 11 g (P < 0.0001) and force-time integral (FTI) 225 versus 415 gs (P < 0.0001); 86% of PVR occurred with a mean CF < 10 g (FTI < 400 gs); and the remaining 14% occurred at ablation sites with a long interlesion distance (≥5 mm) despite mean CF ≥ 10 g. Eighty percent of PVR sites were located anteriorly. There were no significant differences in regard to arrhythmia freedom between the patients without (69%) versus with PVR (67%; P = 1.0).
  
  
  CONCLUSIONS
  Acutely durable PVI can be achieved when RF lesions are delivered with a mean CF ≥ 10 g and an interlesion distance <5 mm. The majority of PVR occur anteriorly due to inadequate CF or long interlesion distances.
authors.affiliation: Arrhythmia Department, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Medizinische Klinik für Kardiologie und Angiologie II, Bad Krozingen, Germany.
authors.forename: Chan-Il
authors.initials: CI
authors.lastname: Park
authors.forename: Heiko
authors.initials: H
authors.lastname: Lehrmann
authors.forename: Cornelius
authors.initials: C
authors.lastname: Keyl
authors.forename: Reinhold
authors.initials: R
authors.lastname: Weber
authors.forename: Jochen
authors.initials: J
authors.lastname: Schiebeling
authors.forename: Juergen
authors.initials: J
authors.lastname: Allgeier
authors.forename: Patrick
authors.initials: P
authors.lastname: Schurr
authors.forename: Ashok
authors.initials: A
authors.lastname: Shah
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Thomas
authors.initials: T
authors.lastname: Arentz
authors.forename: Amir S
authors.initials: AS
authors.lastname: Jadidi
mesh_terms: D000241:Adenosine; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D013997:Time Factors; D014160:Transducers, Pressure; D016896:Treatment Outcome
chemical_list: D000241:Adenosine
keywords: adenosine; atrial fibrillation; catheter ablation; contact force; pulmonary vein isolation; pulmonary vein reconnection