title: Low contact force and force-time integral predict early recovery and dormant conduction revealed by adenosine after pulmonary vein isolation.
abstract: OBJECTIVE
  After pulmonary vein isolation (PVI), dormant conduction (DC) is present in at least one vein in a substantial number of patients. The present study seeks to determine whether there is a relationship between poor contact forces (CF) and the presence of DC after PVI.
  
  
  RESULTS
  This prospective, operator-blinded, non-randomized dual-centre trial enrolled 34 consecutive patients with paroxysmal atrial fibrillation who were candidates for PVI. Radiofrequency (RF) energy was delivered by using an irrigated-tip force-sensing ablation catheter (Tacticath, St Jude Medical) at pre-defined target power. The operators were blinded to the CF data at all times. A total of 1476 RF applications were delivered in 743 pre-defined PV segments. For each application, the precise location of the catheter was registered and the following data were extracted from the Tacisys unit: application duration, minimum contact force, maximum contact force, average contact force (CF), and force-time integral (FTI). Sixty minutes after PVI, spontaneous early recovery (ER) of the left atrium (LA) to PV conduction was evaluated. In the absence of ER, the presence of a DC was evaluated by using intravenous adenosine (ATP). In the 34 patients recruited (23 males; mean age: 62 ± 9 years), all PVs were successfully isolated. At the end of the 60 min waiting period, 22 patients demonstrated at least one spontaneous ER or DC under ATP. The mean CF and FTI per PV segment differed significantly among the different veins but the sites of ER and DC were evenly distributed. However, both the minimum, the first and the mean CF and FTI per PV segment were significantly lower in the PV segments presenting either ER or DC as compared with those without ER or DC (mean CF: 4.9 ± 4.8 vs. 12.2 ± 1.65 g and mean FTI: 297 ± 291 vs. 860 ± 81 g s, P < 0.001 for both). Using multivariate analysis, both the mean CF and the FTI per lesion remained significantly associated with the risk of ER or DC. Moreover, a CF < 5 g per PV segment predicted ER+ and DC+ with a sensitivity of 71% and specificity of 82%. In contrast, ER and DC were very unlikely if RF application was performed with a mean CF > 10 g (negative predictive value: 98.7%).
  
  
  CONCLUSIONS
  Both a low CF and a low FTI are associated with the ER of the PVI and DC after PVI.
authors.affiliation: Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium jean-benoit.lepolain@uclouvain.be.
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: le Polain de Waroux
authors.affiliation: Department of Medicine, University of Western Australia, Crawley, WA, Australia Hollywood Private Hospital, Nedlands, WA, Australia.
authors.forename: Rukshen
authors.initials: R
authors.lastname: Weerasooriya
authors.affiliation: Department of Medicine, University of Western Australia, Crawley, WA, Australia Hollywood Private Hospital, Nedlands, WA, Australia.
authors.forename: Kalilur
authors.initials: K
authors.lastname: Anvardeen
authors.affiliation: Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Barbraud
authors.affiliation: Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Marchandise
authors.affiliation: Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: De Meester
authors.affiliation: Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium.
authors.forename: Cedric
authors.initials: C
authors.lastname: Goesaert
authors.affiliation: Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium.
authors.forename: Ivone
authors.initials: I
authors.lastname: Reis
authors.affiliation: Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10-2881, Brussels 1200, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: Scavee
mesh_terms: D000241:Adenosine; D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000241:Adenosine
keywords: Adenosine; Atrial fibrillation; Contact force; Dormant conduction; Pulmonary vein isolation; Radiofrequency ablation; Tacticath