title: The symbiosis of contact force catheter use for hybrid ablation for atrial fibrillation.
abstract: OBJECTIVE
  Reconduction across an ablation line is a common reason for arrhythmia recurrence over time. The hybrid procedure combines epicardial ablation of the pulmonary vein (PV) and creation of a box lesion with endocardial touch-ups for any electrical gaps. A high contact force (CF) between the ablation tip and cardiac tissue may increase the risk of thrombus formation, catheter tip charring, steam pop formation, and even cardiac perforation. CF monitoring is a significant new parameter for titration of the CF for creating an adequate lesion.
  
  
  METHODS
  Thirty-eight consecutive patients underwent epicardial ablation using bipolar radiofrequency devices. After checking electrical bidirectional block of the ablation lines, an endocardial CF catheter was used for further ablation (if needed) to complete the isolation of PVs, box lesion, cavotricuspid isthmus (CTI), and complex fractionated atrial electrograms (CFAE).
  
  
  RESULTS
  Endocardial touch-up was needed for 2 PVs (1.3 %) and 10 (26.3 %) box lesions. It was also used for the CTI line in 7 (18.4 %) patients, atrial tachycardia in 3 (7.9 %) patients, and additional CFAE ablation in 17 (44.7 %) patients. All 5 patients with arrhythmia recurrence had a mean CF < 10 g (p = 0.03). Procedure duration was significantly shorter in the CF group (223 ± 57 vs. 256 ± 60 min, p = 0.03) compared with control group.
  
  
  CONCLUSIONS
  Use of CF catheters is safe, feasible, and complementary to a hybrid procedure setup for atrial fibrillation ablation. Its real-time monitoring may predict future arrhythmia recurrence, and decrease procedure time.
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), P. Debyelaan 25, PO Box 5800, 6229 HX, Maastricht, The Netherlands, drnarendra007kr@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Kumar
authors.forename: L
authors.initials: L
authors.lastname: Pison
authors.forename: P
authors.initials: P
authors.lastname: Lozekoot
authors.forename: R
authors.initials: R
authors.lastname: Choudhury
authors.forename: M
authors.initials: M
authors.lastname: La Meir
authors.forename: S
authors.initials: S
authors.lastname: Gelsomino
authors.forename: H
authors.initials: H
authors.lastname: Crijns
authors.forename: J
authors.initials: J
authors.lastname: Maessen