title: Optimization of catheter/tissue contact during pulmonary vein isolation: the impact of atrial rhythm.
abstract: During pulmonary vein isolation (PVI), even if operators are aware of the contact force (CF), its values may greatly vary and the impact of cardiac rhythm has not been thoroughly investigated yet. This study aims at assessing the actual values of CF, the applications with suboptimal CF, and the impact of cardiac rhythm on CF during PVI.
  
  
  
  Twenty patients undergoing point-by-point PVI with a CF-sensing catheter were considered. CF target was between 6 and 40 g. The mean CF per application (mCF) was evaluated and considered suboptimal if ≤5 g. The real-time graphic of CF was also evaluated and classified as pulsatile if regular variations synchronous with the atrial rate were seen; otherwise it was irregular. To achieve PVI, 1458 applications were delivered; 287 (19.68%) had suboptimal mCF. A great variability of mCF was seen according to anatomy, operators and patients. Compared to applications in atrial fibrillation (AF), those in sinus rhythm (SR) showed a higher median value of mCF (11 vs. 9 g; P = 0.0099) and a lower percentage of suboptimal mCF (17.95% vs. 25.15%; P = 0.0051). Compared to the irregular, the pulsatile pattern, almost exclusively observed in SR, was associated with higher mCF (14.69 ± 8.77 vs. 10.79 ± 7.89 g; P < 0.0001) and fewer suboptimal applications (8.02% vs. 27.73%; P < 0.0001).
  
  
  
  During PVI, several factors influence CF, which, despite optimization attempts, can be suboptimal in ∼20% of the applications. However, CF is higher in SR than in AF and this is strictly associated with a pulsatile pattern of instant CF values.
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, 2100 Varese, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: De Ponti
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, 2100 Varese, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Marazzi
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, 2100 Varese, Italy.
authors.forename: Lorenzo A
authors.initials: LA
authors.lastname: Doni
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, 2100 Varese, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Marazzato
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, 2100 Varese, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Baratto
authors.affiliation: Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, 2100 Varese, Italy.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Salerno-Uriarte
mesh_terms: D000200:Action Potentials; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Contact force sensing; Pulmonary vein isolation; Radiofrequency energy