title: Comparison of lesion formation between contact force-guided and non-guided circumferential pulmonary vein isolation: a prospective, randomized study.
abstract: BACKGROUND
  Contact force (CF) monitoring could be useful in accomplishing circumferential pulmonary vein (PV) isolation (CPVI) for atrial fibrillation (AF).
  
  
  OBJECTIVE
  The purpose of this study was to compare procedure parameters and outcomes between CF-guided and non-guided CPVI.
  
  
  METHODS
  Thirty-eight consecutive AF patients (mean age 60 ± 11 years, 28 paroxysmal AF) undergoing CPVI were randomized to non-CF-guided (n = 19) and CF-guided (n = 19) groups. CPVI was performed with the ThermoCool SmartTouch catheter in both groups. The end-point was bidirectional block between the left atrium (LA) and PV. In the CF group, CF was kept between 10 and 20 g during CPVI, whereas in the non-CF group, all CF information was blanked. Radiofrequency energy at 30 W in the anterior and 25 W in the posterior LA wall was applied for 20-25 seconds at each point.
  
  
  RESULTS
  CPVI was successfully accomplished without any major complications in both groups. Mean CF in the non-CF and CF groups were 5.9 ± 4.5 g and 11.1 ± 4.3 g, respectively, for left-side CPVI, and 9.8 ± 6.6 g and 12.1 ± 4.8 g, respectively, for right-side CPVI (both P <.001). The procedure and fluoroscopy times for CPVI in the non-CF and CF groups were 96 ± 39 minutes and 59 ± 16 minutes, respectively (P <.001), and 22 ± 63 seconds and 9 ± 20 seconds (P = NS), respectively. Total number of residual conduction gaps was 6.3 ± 3.0 in the non-CF group and 2.8 ± 1.9 in the CF group (P <.001). During 6-month follow-up, 84.2% of patients in the non-CF group and 94.7% in the CF group were free from any atrial tachyarrhythmias (P = .34).
  
  
  CONCLUSIONS
  CF-guided CPVI is effective in reducing procedure time and additional touch-up ablation and may improve long-term outcome.
authors.affiliation: Department of Cardiology.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Kimura
authors.affiliation: Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Department of Cardiology.
authors.forename: Shingen
authors.initials: S
authors.lastname: Owada
authors.affiliation: Department of Cardiology.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Horiuchi
authors.affiliation: Department of Cardiology.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Taihei
authors.initials: T
authors.lastname: Itoh
authors.affiliation: Department of Cardiology.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Department of Cardiology.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Kinjo
authors.affiliation: Department of Cardiology.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tomita
authors.affiliation: Department of Cardiology. Electronic address: okumura@cc.hirosaki-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D014057:Tomography, X-Ray Computed
keywords: Atrial fibrillation; Catheter ablation; Computed tomography; Contact force; Fluoroscopy time; Pulmonary vein isolation