title: Randomized comparison of contact force-guided versus conventional circumferential pulmonary vein isolation of atrial fibrillation: prevalence, characteristics, and predictors of electrical reconnections and clinical outcomes.
abstract: OBJECTIVE
  We prospectively investigated the differences in pulmonary vein reconnections (PVRs) and clinical outcomes between contact force (CF)-guided and conventional circumferential PV isolation (CPVI) of atrial fibrillation (AF).
  
  
  METHODS
  One hundred twenty consecutive AF patients (63 ± 10 years; 88 males) undergoing an initial CPVI were randomized to ablation with a target CF of 20 g (CF group; n = 60) or that with operators blinded to the CF information (blind group; n = 60).
  
  
  RESULTS
  The CF group had fewer PVRs (0.67 ± 0.91/patient vs. 1.16 ± 1.16/patient; P = 0.007), a lower incidence of persistent PVRs (13.2 vs. 41.2%; P < 0.001), and a shorter procedural time for the CPVI (50 vs. 56 min; P = 0.019) than the blind group. The mean CF was higher in the CF group than the blind group (18.0 vs. 16.1 g; P < 0.001), with the most significant difference observed along the posterior right-sided PVs (P-RPVs) and anterior left-sided PVs (A-LPVs). In logistic regression models, the mean CF was a negative predictor of PVRs along the P-RPVs and A-LPVs in the blind group (odds ratios, 0.728 and 0.786; P < 0.001 and 0.007), while no significant predictor was identified in the CF group or elsewhere in the blind group. In the Kaplan-Meier analysis, the arrhythmia-free survival rate at 12 months was 89.9% in the CF group and 88.2% in the blind group, respectively (P = 0.624).
  
  
  CONCLUSIONS
  CF-guided CPVI can reduce PVRs and the procedural time and be particularly beneficial along regions where a relatively low CF tends to be applied: the P-RPVs and A-LPVs. The comparable clinical outcomes may be due to the learning curve effect obtained by the CF-guided technique and repeated provocation of dormant PV conduction.
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan. kohkinakamura@yahoo.co.jp.
authors.forename: Kohki
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
authors.forename: Takehito
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Minami
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakatani
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Yamashita
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kumagai
authors.affiliation: Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
authors.forename: Nobusada
authors.initials: N
authors.lastname: Funabashi
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, 3-12 Kameizumi-machi, Maebashi City, Gunma, 371-0004, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D013314:Stress, Mechanical; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Atrial fibrillation; Contact force; Pulmonary vein isolation; Pulmonary vein reconnection; Radiofrequency catheter ablation