Contact force threshold for permanent lesion formation in atrial fibrillation ablation: A cardiac magnetic resonance-based study to detect ablation gaps.
BACKGROUND
Catheter contact force (CF) has a strong correlation with lesion formation during radiofrequency ablation. Delayed-enhancement cardiac magnetic resonance (DE-CMR) provides lesion information in patients with prior atrial fibrillation (AF) ablation.


OBJECTIVE
The aim of this study was to determine the CF threshold to create permanent lesions detected by DE-CMR.


METHODS
A total of 36 patients referred for AF ablation were included. A CF catheter was used during the ablation procedure, and DE-CMR was performed 3 months after the ablation procedure. Eighteen pulmonary vein (PV) segments were defined, and 3-dimensional (3D) reconstructions of the left atrium (LA) derived from the DE-CMR images were obtained. One observer evaluated the presence of any discontinuity of previous ablation lesions (gap) in the 3D reconstructions of the LA, and another observer (blinded to the gap findings) determined the minimum CF value in each PV segment.


RESULTS
The PV segments where a gap was observed had a lower maximal CF value than did the segments without gap in the 3D LA reconstructions (6.7 ± 4.4 g vs 12.2 ± 4.7 g; P < .001). In receiver operating characteristic analysis, a CF threshold of >8 g provided 73% sensitivity and 81% specificity in the prediction of a complete PV lesion (positive predictive value [PPV] 84%). A CF threshold of >12 g had a specificity of 94% and increased the PPV to 91% in creating a complete lesion in the LA wall (area under the curve 0.834).


CONCLUSIONS
A CF threshold of >12 g H5H20 predicts a complete lesion with high specificity and PPV when a dragging ablation strategy is used in AF ablation.
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
David
D
Andreu
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Federico
F
Gomez-Pulido
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Mireia
M
Calvo
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Alicia
A
Carlosena-Remírez
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Felipe
F
Bisbal
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Roger
R
Borràs
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Eva
E
Benito
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Eduard
E
Guasch
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Susanna
S
Prat-Gonzalez
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Rosario J
RJ
Perea
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Josep
J
Brugada
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain.
Antonio
A
Berruezo
Unitat de Fibril·lació Auricular (UFA), Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunye (IDIBAPS) Barcelona, Catalonia, Spain. Electronic address: lmont@clinic.ub.es.
Lluís
L
Mont
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D002921:Cicatrix / Q000175:diagnosis*; D011211:Electric Power Supplies / Q000592:standards; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011667:Pulmonary Veins / Q000601:surgery*; D055502:Secondary Prevention / Q000379:methods; D013997:Time Factors
Ablation lesion; Atrial fibrillation ablation; Cardiac magnetic resonance; Contact force; Delayed-enhancement; Gaps; Pulmonary vein