TY - JOUR
T1 - Contact force sensing for ablation of persistent atrial fibrillation
T2 - A randomized, multicenter trial
AU - Conti, Sergio
AU - Weerasooriya, Rukshen
AU - Novak, Paul
AU - Champagne, Jean
AU - Lim, Hong Euy
AU - Macle, Laurent
AU - Khaykin, Yaariv
AU - Pantano, Alfredo
AU - Verma, Atul
N1 - Publisher Copyright:
© 2017 Heart Rhythm Society
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2018/2
Y1 - 2018/2
N2 - Background Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. Objective The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Methods Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. Results PeAF was continuous for 26 weeks (interquartile range [IQR] 13–52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6–20] and 14 g [IQR 9–20] (P =.10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P =.70). Single procedure freedom from atrial arrhythmia was 60% in the CFS-guided arm and 63% in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6–19] vs 13.2 g [IQR 8–20], respectively; P =.0007) and less force-time integral (174 gs [IQR 91–330] vs 210 gs [IQR 113–388], respectively; P <.001). Conclusion CFS-guided ablation resulted in no difference to RF time or 12-month outcome. Lower force/force-time integral was associated with significantly more gaps.
AB - Background Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. Objective The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Methods Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. Results PeAF was continuous for 26 weeks (interquartile range [IQR] 13–52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6–20] and 14 g [IQR 9–20] (P =.10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P =.70). Single procedure freedom from atrial arrhythmia was 60% in the CFS-guided arm and 63% in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6–19] vs 13.2 g [IQR 8–20], respectively; P =.0007) and less force-time integral (174 gs [IQR 91–330] vs 210 gs [IQR 113–388], respectively; P <.001). Conclusion CFS-guided ablation resulted in no difference to RF time or 12-month outcome. Lower force/force-time integral was associated with significantly more gaps.
KW - Ablation
KW - Contact force
KW - Persistent atrial fibrillation
KW - Pulmonary vein isolation
KW - Trial
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U2 - 10.1016/j.hrthm.2017.10.010
DO - 10.1016/j.hrthm.2017.10.010
M3 - Article
C2 - 29030237
AN - SCOPUS:85034636774
SN - 1547-5271
VL - 15
SP - 201
EP - 208
JO - Heart Rhythm
JF - Heart Rhythm
IS - 2
ER -