title: Optimizing radiofrequency ablation of paroxysmal and persistent atrial fibrillation by direct catheter force measurement-a case-matched comparison in 198 patients.
abstract: BACKGROUND
  Sufficient electrode-tissue contact is crucial for adequate lesion formation in radiofrequency catheter ablation (RFCA).
  
  
  OBJECTIVE
  We assessed the impact of direct catheter force measurement on acute procedural parameters and outcome of RFCA for paroxysmal and persistent atrial fibrillation (AF).
  
  
  METHODS
  Ninety-nine consecutive patients (70% men) with paroxysmal (63.6%) or persistent AF underwent left atrial RFCA using a 3.5-mm open-irrigated-tip (OIT) catheter with contact force measurement capabilities (group 1). For comparison a case-matched cohort with standard OIT catheters was used (99 patients; group 2). Case matching included gender, type of AF, number or RFCA procedures, and type of procedure.
  
  
  RESULTS
  Procedural data showed a significant decline in radiofrequency ablation time from 52 ± 20 to 44 ± 16 minutes (P = 0.003) with a remarkable mean reduction in overall procedure time of 34 minutes (P = 0.0001; 225.8 ± 53.1 vs 191.9 ± 53.3 minutes). In parallel, the total fluoroscopy time could be significantly reduced from 28.5 ± 11.0 to 19.9 ± 9.3 minutes (P = 0.0001) as well as fluoroscopy dose from 74.1 ± 58.0 to 56.7 ± 38.9 Gy/cm(2) (P = 0.016). Periprocedural complications were similar in both groups.
  
  
  CONCLUSIONS
  The use of contact force sensing technology is able to significantly reduce ablation, procedure, and fluoroscopy times as well as dose in RFCA of AF in a mixed case-matched group of paroxysmal and persistent AF. Energy delivery is substantially reduced by avoiding radiofrequency ablation in positions with insufficient surface contact. Additionally 12-month outcome data showed increased efficacy. Such time saving and equally safe technology may have a relevant impact on laboratory management and increased cost effectiveness.
authors.affiliation: Department of Cardiology, Elisabethinen University Teaching Hospital of the Universities Innsbruck, Vienna, Graz, Linz, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sigmund
authors.forename: Helmut
authors.initials: H
authors.lastname: Puererfellner
authors.forename: Michael
authors.initials: M
authors.lastname: Derndorfer
authors.forename: Georgios
authors.initials: G
authors.lastname: Kollias
authors.forename: Siegmund
authors.initials: S
authors.lastname: Winter
authors.forename: Josef
authors.initials: J
authors.lastname: Aichinger
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Nesser
authors.forename: Martin
authors.initials: M
authors.lastname: Martinek
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011859:Radiography; D013314:Stress, Mechanical; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D014110:Touch; D016896:Treatment Outcome
keywords: atrial fibrillation; contact force; economic benefit; outcome; radiation; radiofrequency catheter ablation