title: Impact of Contact Force Monitoring in Acute Pulmonary Vein Isolation Using an Anatomic Approach. A Randomized Study.
abstract: The impact of contact force (CF) monitoring in pulmonary vein (PV) isolation after a circumferential anatomic ablation (CAA) is unknown. We analyze the usefulness of CF monitoring in acute PV isolation and procedure parameters using a CAA.
  
  
  
  Fifty patients with paroxysmal atrial fibrillation were randomized into CF-on (CF >10 grams; n = 25) or CF-off (CF blinded; n = 25) groups. We performed a first round of CAA with a ThermoCool(®) SmartTouch(®) catheter blinded to the LASSO(®) catheter (Biosense Webster, Diamond Bar, CA, USA), with radiofrequency (RF) lesions tagged with the VisiTag(™) Module. After the CAA, each PV was reviewed with the LASSO(®) catheter recording the segments with gaps.
  
  
  
  All the PVs were isolated with a CAA in 20 patients of the CF-on versus eight of the CF-off (P = 0.001). Of the 45 segments with gaps in the left PVs, 38 were from the CF-off (P = 0.0001). Of the eight segments with gaps in the right PVs, seven were from the CF-off (P = 0.06). The CF in the left PVs was higher in the CF-on (16.3 ± 3.2 grams vs 10.5 ± 4.3 grams; P = 0.0001) and similar in the right PVs (17.6 ± 3.6 grams vs 15.2 ± 5.3 grams; P = 0.08). All of the gaps were closed with additional RF LASSO(®) -guided touch-up. Procedure and fluoroscopy times were shorter in the CF-on (139 ± 24 minutes vs 157 ± 32 minutes and 20 ± 6 minutes vs 24 ± 7 minutes; both P = 0.039). At 12 months the patients free of AF recurrence was 84% CF-on versus 75% CF-off (log-rank P = 0.4) [corrected].
  
  
  
  In paroxysmal atrial fibrillation, a CAA guided by CF reduces PV gaps and shortens the procedure parameters at the expense of the left PVs.
authors.affiliation: Arrhythmia Unit, Cardiology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Alonso
authors.initials: A
authors.lastname: Pedrote
authors.affiliation: Arrhythmia Unit, Cardiology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arana-Rueda
authors.affiliation: Arrhythmia Unit, Cardiology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Arce-León
authors.affiliation: Arrhythmia Section, Cardiology Department, Hospital Clínic, Thorax Institute, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Acosta
authors.affiliation: Arrhythmia Unit, Cardiology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Gómez-Pulido
authors.affiliation: Arrhythmia Unit, Cardiology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Martos-Maine
authors.affiliation: Arrhythmia Unit, Cardiology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Frutos-López
authors.affiliation: Arrhythmia Unit, Cardiology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sánchez-Brotons
authors.affiliation: Arrhythmia Unit, Cardiology Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: García-Riesco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation* / Q000379:methods; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006329:Heart Conduction System / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008328:Man-Machine Systems; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D013314:Stress, Mechanical; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Carto system; atrial fibrillation ablation; contact force monitoring; pulmonary vein gaps; radiofrequency ablation