title: Contact-force-guided vs. contact-force-blinded catheter ablation of typical atrial flutter: a prospective study.
abstract: OBJECTIVE
  It remains unknown whether contact force (CF) sensing technology is of value for cavotricuspid isthmus (CTI) ablation. We prospectively evaluated procedural parameters and outcomes of CF-guided vs. CF-blinded CTI ablation for typical atrial flutter (AFL).
  
  
  RESULTS
  A total of 70 consecutive patients (62.5 ± 10.9 years) undergoing CTI ablation for AFL were prospectively enrolled, 35 in CF-blinded and 35 in CF-guided groups. A CF-sensing catheter (power 25-35 W) was used in all. In the CF-guided group, CF target range was 10-25 g, whereas in the CF-blinded group, the operator was blinded to CF. The isthmus was divided into anterior, middle, and posterior segments for region-specific CF analysis. The procedural endpoint of bidirectional isthmus block following a 20-min observation period was achieved in all. A trend towards lower fluoroscopy and procedure duration was observed when the CF-guided group was compared with the CF-blinded group. The total radiofrequency (RF) energy delivery time required to achieve bidirectional block was significantly lower in the CF-guided vs. CF-blinded group [10.0 min (IQR 8.3;15.1) vs. 15.9 min (IQR 9.6;24.7), P= 0.0020], with a significant inverse correlation between CF and total RF delivery time (r = -0.36; P= 0.0027). Mean CF measurements significantly increased from anterior to posterior anatomical zones of CTI in the CF-blinded group (ANOVA P= 0.0466).
  
  
  CONCLUSIONS
  Catheter ablation of AFL guided by real-time CF assessment results in a significant reduction in total RF delivery time. Real-time CF measurements facilitate the maintenance of homogenous efficient contact all along the CTI, particularly in the anterior segment where CF is generally lower.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Venier
authors.forename: Jason G
authors.initials: JG
authors.lastname: Andrade
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Blandine
authors.initials: B
authors.lastname: Mondésert
authors.forename: Katia
authors.initials: K
authors.lastname: Dyrda
authors.forename: Léna
authors.initials: L
authors.lastname: Rivard
authors.forename: Peter G
authors.initials: PG
authors.lastname: Guerra
authors.forename: Marc
authors.initials: M
authors.lastname: Dubuc
authors.forename: Bernard
authors.initials: B
authors.lastname: Thibault
authors.forename: Mario
authors.initials: M
authors.lastname: Talajic
authors.forename: Denis
authors.initials: D
authors.lastname: Roy
authors.forename: Laurent
authors.initials: L
authors.lastname: Macle
mesh_terms: D000200:Action Potentials; D000368:Aged; D000704:Analysis of Variance; D001282:Atrial Flutter / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014160:Transducers, Pressure; D016896:Treatment Outcome
keywords: Ablation; Atrial flutter; Cavotricuspid isthmus; Contact force; Three-dimensional electroanatomic mapping