title: Use of a contact force-sensing ablation catheter with advanced catheter location significantly reduces fluoroscopy time and radiation dose in catheter ablation of atrial fibrillation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the 'real-world' impact of a novel contact force (CF)-sensing (SmartTouch™, Biosense Webster, Diamond Bar, CA, USA) catheter coupled with an advanced catheter location (ACL) system on fluoroscopy time and fluoroscopy dose during atrial fibrillation (AF) ablation.
  
  
  RESULTS
  This was a retrospective observational cohort study of prospectively collected data of 1515 consecutive patients undergoing paroxysmal AF (PAF) and persistent AF (PerAF) ablation at a single institution between 2009 and 2014. Patients undergoing AF ablation with the SmartTouch catheter and the ACL system (SmartTouch group, n = 510) were compared with those undergoing AF ablation without this technology (control group, n = 1005). The primary outcomes were total fluoroscopy time (min) and fluoroscopy dose as measured by the dose-area product (mGy cm(2)). Secondary endpoints included total procedure time, total ablation time, and major cardiac complications (tamponade, pericardial effusion, and urgent cardiac surgery). The SmartTouch group had significantly lower fluoroscopy times (9.5 vs. 41 min, P < 0.001), radiation doses (1044 vs. 3571 mGy cm(2), P < 0.001), and shorter procedural time (195 vs. 240 min, P < 0.001) when compared with the control group. This was statistically significant for both PAF and PerAF ablations and for both de novo and redo AF procedures. After a learning curve, a median fluoroscopy time of 3.5 min (interquartile range 6) for all AF ablations was achieved. There was no difference in the rate of cardiac complications (∼ 1.5%).
  
  
  CONCLUSIONS
  SmartTouch™ CF-sensing catheter use with ACL™ during AF ablation significantly reduces fluoroscopy times by 77%, radiation dose by 71%, and procedural time by 19% but does not improve overall safety or the risk of cardiac complications.
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK Department of Cardiology, The Royal Melbourne Hospital and The Department of Medicine, University of Melbourne, Australia.
authors: Geoffrey
authors: G
authors: Lee
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
authors: Ross J
authors: RJ
authors: Hunter
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
authors: Matthew J
authors: MJ
authors: Lovell
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
authors: Malcom
authors: M
authors: Finlay
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
authors: Waqas
authors: W
authors: Ullah
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
authors: Victoria
authors: V
authors: Baker
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
authors: Mehul B
authors: MB
authors: Dhinoja
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
authors: Simon
authors: S
authors: Sporton
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK.
authors: Mark J
authors: MJ
authors: Earley
authors: Cardiovascular Biomedical Research Unit, St Bartholomew's Hospital, Barts Health NHS Trust, First Floor Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK richard.schilling@bartshealth.nhs.uk.
authors: Richard J
authors: RJ
authors: Schilling
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D002983:Clinical Competence; D004867:Equipment Design; D005471:Fluoroscopy; D006801:Humans; D059032:Learning Curve; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control*; D015641:Radiography, Interventional / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014160:Transducers, Pressure; D016896:Treatment Outcome
keywords: Ablation; Atrial fibrillation; Contact force; Fluoroscopy; Radiation