title: Contact-force guided single-catheter approach for pulmonary vein isolation: Feasibility, outcomes, and cost-effectiveness.
abstract: For conventional ablation of paroxysmal atrial fibrillation (AF), an ablation catheter in conjunction with a circular mapping catheter (CMC) is typically used for pulmonary vein isolation (PVI).
  
  
  
  The purpose of this study was to evaluate an approach for PVI with a single contact-force (CF) ablation catheter in terms of procedural reliability, outcomes, and cost-effectiveness.
  
  
  
  One hundred consecutive patients with paroxysmal AF were included in the study. Fifty patients (study group) underwent a CF-guided single-catheter approach, whereby PVI was demonstrated when sequential pacing at 9 equidistant points within the lesion set (carina included) failed to capture the left atrium. For confirmation, PVI was verified with a CMC. In comparison, 50 patients (control group) underwent a conventional PVI ablation guided by a CMC.
  
  
  
  Procedure time (101 ± 17 minutes vs 107 ± 15 minutes, P = .11), ablation time (24.2 ± 7.1 minutes vs 22.6 ± 8.8 minutes, P = .37), fluoroscopy time (5.6 ± 2.2 minutes vs 8.3 ± 3.4 minutes, P = .09), and applied CF (17.8 ± 2.6 g vs 18 ± 2.8 g, P = .72) did not reach statistical difference between the study and control groups. CF-guided single-catheter ablation achieved successful PVI in 98% of the study group and a 31% reduction in cost. At 1-year follow-up, sinus rhythm maintenance rate was similar in both groups (86% vs 84%, P = .78).
  
  
  
  In paroxysmal AF, a CF-guided single-catheter technique is an effective method for PVI, yielding substantial cost savings and clinical results similar to a conventional approach.
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France,; Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France. Electronic address: thomaspambrun@aol.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pambrun
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Combes
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: Pedro
authors.initials: P
authors.lastname: Sousa
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France,; Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Mathieu Le
authors.initials: ML
authors.lastname: Bloa
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: Rim
authors.initials: R
authors.lastname: El Bouazzaoui
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Grand-Larrieu
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Thompson
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Ruairidh
authors.initials: R
authors.lastname: Martin
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combes
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Département de Rythmologie, Clinique Pasteur, Toulouse, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Albenque
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods / Q000706:statistics & numerical data; D005602:France; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011667:Pulmonary Veins / Q000601:surgery*; D015203:Reproducibility of Results
keywords: Antral exit block; Atrial fibrillation; Catheter ablation; Contact-force sensing; Radiofrequency ablation