Regional difference of optimal contact force to prevent acute pulmonary vein reconnection during radiofrequency catheter ablation for atrial fibrillation.
BACKGROUND
Regional differences in optimal contact force (CF) to prevent acute pulmonary vein reconnection (APVR) during catheter ablation for atrial fibrillation (AF) remain unclear.


OBJECTIVE
The purpose of this study was to evaluate regional difference in optimal CF during AF ablation.


METHODS
This single-center observational study evaluated data from 57 consecutive drug-refractory AF patients (mean age, 62 ± 11 years; 43 males) who underwent initial pulmonary vein isolation (PVI) using the THERMOCOOL® SMARTTOUCH™ (Biosense Webster, Diamond Bar, CA, USA) catheter from June to August 2013. APVR was defined as the time-dependent reconnection >20 minutes after initial PVI and/or reconnection evoked by intravenous adenosine administration (20 mg). Point-by-point relationships between the reconnected points and their CF values were evaluated.


RESULTS
Total 72 gaps causing APVR were observed. Of a total of 4,421 ablation points, 285 (6.4%) were associated with APVR. The average CF value of the points with APVR was significantly lower than that of those without (APVR vs. no APVR; 7.5 ± 6.7 g vs. 9.9 ± 8.4 g; P < 0.0001). The areas under the curve and optimal CF values differed between segments (range 0.593-0.761 and 10-22 g, respectively). The optimal CF value was highest in bottom of the right PV and posterosuperior right PV segments (22 g) and lowest in posteroinferior right PV segment (10 g).


CONCLUSIONS
There was a regional difference in optimal CF values to prevent APVR, and the optimal CF value to prevent APVR with >95% probability was 10-22 g, depending on the individual peri-PV segments.
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Yohei
Y
Sotomi
Department of Medical Engineering, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Takayuki
T
Kikkawa
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Koichi
K
Inoue
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Koji
K
Tanaka
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Yuko
Y
Toyoshima
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Takafumi
T
Oka
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Nobuaki
N
Tanaka
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Yoichi
Y
Nozato
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Yoshiyuki
Y
Orihara
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Katsuomi
K
Iwakura
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Yasushi
Y
Sakata
Department of Cardiology, Sakurabashi-Watanabe Hospital, Osaka, Japan.
Kenshi
K
Fujii
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
acute pulmonary vein reconnection; atrial fibrillation; catheter ablation; contact force; pulmonary vein isolation