Reduced residual conduction gaps and favourable outcome in contact force-guided circumferential pulmonary vein isolation.
OBJECTIVE
Although contact force (CF)-guided circumferential pulmonary vein isolation (CPVI) for paroxysmal atrial fibrillation (PAF) is useful, AF recurrence at long-term follow-up still remains to be resolved. The purpose of this study was to assess safety and efficacy of CF-guided CPVI and to compare residual conduction gaps during CPVI and long-term outcome between the conventional (non-CF-guided) and the CF-guided CPVI.


RESULTS
We studied the 50 consecutive PAF patients undergoing CPVI by a ThermoCool EZ Steer catheter (conventional group, mean age 61 ± 10 years) and the other 50 consecutive PAF patients by a ThermoCool SmartTouch catheter (CF group, 65 ± 11 years). The procedure parameters and residual conduction gaps during CPVI, and long-term outcome for 12 months were compared between the two groups. Circumferential pulmonary vein isolation was successfully accomplished without any major complications in both groups. Total procedure and total fluoroscopy times were both significantly shorter in the CF group than in the conventional group (160 ± 30 vs. 245 ± 61 min, P < 0.001, and 17 ± 8 vs. 54 ± 27 min, P < 0.001, respectively). Total number of residual conduction gaps was significantly less in the CF group than in the conventional group (2.7 ± 1.7 vs. 6.3 ± 2.7, P < 0.05). The AF recurrence-free rates after CPVI during 12-month follow-up were 96% (48/50) in the CF group and 82% (41/50) in the conventional group (P = 0.02 by log rank test). Multivariate Cox regression analysis further supported this finding.


CONCLUSIONS
Contact force-guided CPVI is safe and more effective in reducing not only the procedure time but also the AF recurrence than the conventional CPVI, possibly due to reduced residual conduction gaps during CPVI procedure.
Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
Taihei
T
Itoh
Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
Masaomi
M
Kimura
Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
Hirofumi
H
Tomita
Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
Shingo
S
Sasaki
Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
Shingen
S
Owada
Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan.
Daisuke
D
Horiuchi
Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
Kenichi
K
Sasaki
Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
Yuji
Y
Ishida
Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan.
Takahiko
T
Kinjo
Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan okumura@hirosaki-u.ac.jp.
Ken
K
Okumura
D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D016016:Proportional Hazards Models; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Ablation; Atrial fibrillation; Circumferential pulmonary vein isolation; Contact force; Residual conduction gap