title: Relationship between contact force sensing technology and medium-term outcome of atrial fibrillation ablation: a multicenter study of 600 patients.
abstract: BACKGROUND
  Contact force sensing (CFS) technology improves acute pulmonary vein isolation durability; however, its impact on the clinical outcome of ablating atrial fibrillation (AF) is unknown.
  
  
  RESULTS
  First time AF ablation procedures employing CFS from 4 centers were matched retrospectively to those without CFS in a 1:2 manner by type of AF. Freedom from atrial tachyarrhythmia was defined as the primary outcome measure, and fluoroscopy time the secondary outcome measure. Nineteen possible explanatory variables were tested in addition to CFS. A total of 600 AF ablation procedures (200 using CFS and 400 using non-CFS catheters) performed between 2010 and 2012 (46% paroxysmal, 36% persistent, 18% long-lasting persistent) were analyzed. The mean follow-up duration was 11.4 ± 4.7 months-paroxysmal AF 11.2 ± 4.1 CFS versus 11.3 ± 3.9 non-CFS (P = 0.745)-nonparoxysmal AF 10.4 ± 4.5 CFS versus 11.9 ± 5.4 non-CFS (P = 0.015). The use of a CFS catheter independently predicted clinical success in ablating paroxysmal AF (HR 2.24 [95% CIs 1.29-3.90]; P = 0.004), but not nonparoxysmal AF (HR 0.73 [0.41-1.30]; P = 0.289) in a multivariate analysis that included follow-up duration. Among all cases, the use of CFS catheters was associated with reduced fluoroscopy time in multivariate analysis (reduction by 7.7 [5.0-10.5] minutes; P < 0.001). Complication rates were similar in both groups.
  
  
  CONCLUSIONS
  At medium-term follow-up, CFS catheter technology is associated with significantly improved outcome of first time catheter ablation of paroxysmal AF, but not nonparoxysmal AF. Fluoroscopy time was lower when CFS technology was employed in all types of AF ablation procedures.
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.|Imperial College London, UK.
authors.forename: Julian W E
authors.initials: JWE
authors.lastname: Jarman
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.|Imperial College London, UK.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Panikker
authors.affiliation: Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.|Imperial College London, UK.
authors.forename: Moloy
authors.initials: M
authors.lastname: DAS
authors.affiliation: Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.|Imperial College London, UK.
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Wynn
authors.affiliation: St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.|Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine and Dentistry, London, UK.
authors.forename: Waqas
authors.initials: W
authors.lastname: Ullah
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.|Imperial College London, UK.
authors.forename: Andrianos
authors.initials: A
authors.lastname: Kontogeorgis
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.|Imperial College London, UK.
authors.forename: Shouvik K
authors.initials: SK
authors.lastname: Haldar
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.|Imperial College London, UK.
authors.forename: Preya J
authors.initials: PJ
authors.lastname: Patel
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.|Imperial College London, UK.
authors.forename: Wajid
authors.initials: W
authors.lastname: Hussain
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.|Imperial College London, UK.
authors.forename: Vias
authors.initials: V
authors.lastname: Markides
authors.affiliation: Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.|Imperial College London, UK.
authors.forename: Dhiraj
authors.initials: D
authors.lastname: Gupta
authors.affiliation: St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.|Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine and Dentistry, London, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Institute of Cardiovascular Medicine and Science, The Royal Brompton and Harefield NHS Foundation Trust & Imperial College London, UK.|Imperial College London, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004739:England; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; atrioesophageal fistula; catheter ablation; contact force; pulmonary vein isolation; stroke