title: Comparison of contact force-guided procedure with non-contact force-guided procedure during left atrial mapping and pulmonary vein isolation: impact of contact force on recurrence of atrial fibrillation.
abstract: BACKGROUND
  The aim of this study was to evaluate the impact of contact force (CF) visualization on the incidence of low and high CF during left atrial (LA) mapping and pulmonary vein isolation (PVI).
  
  
  METHODS
  CF was assessed in 70 patients who underwent PVI. Three highly experienced operators performed all procedures. The operators were blinded to CF in group A (35 patients), and CF was displayed in group B (35 patients). In group B, optimal CF was defined as mean CF between 10 and 39g, and operators attempted to acquire points and ablate within this range.
  
  
  RESULTS
  A total of 8401 mapping points were analyzed during LA mapping (group A: 4104, group B: 4297). Low CF <10g and high CF ≥40g were noted in a significantly larger number of points in group A (37.7 vs. 12.0 %, P < 0.001; 11.5 vs. 1.5 %, P < 0.001). At the mitral isthmus and ridge areas, CF was significantly lower (7.7 vs. 12.2g, P < 0.001; 5.3 vs. 11.7g, P < 0.001) in group A than in group B. PVI was successfully achieved in all patients. There were significant site-dependent CF differences between the two groups. Optimal CF was achieved in significantly more applications in group B (P < 0.001). There was no significant difference in atrial fibrillation (AF) recurrence rates after a minimum follow-up of 1 year between the two groups in this cohort (P = 0.24). No significant peri-procedural complications occurred in either group.
  
  
  CONCLUSIONS
  CF visualization can assist in avoiding both low and high CF, which may have the potential to improve lesion formation and patient safety profile. In this study, CF-guided ablation did not affect AF recurrence.
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Hisaki
authors.initials: H
authors.lastname: Makimoto
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Christian-H
authors.initials: CH
authors.lastname: Heeger
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Shibu
authors.initials: S
authors.lastname: Mathew
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Deiss
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rausch
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Lemeš
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany.
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmuehlenstr 5, 20099, Hamburg, Germany. tilz6@hotmail.com.
authors.forename: Roland Richard
authors.initials: RR
authors.lastname: Tilz
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: Atrial fibrillation; Contact force; Pulmonary vein isolation