Abstract 2859: Catheter Contact Force During Ablation of Atrial Flutter and Atrial Fibrillation: Results From the TOCCATA Multi-Center Clinical Study
Introduction: During ablation, catheter contact force (CF) with the target tissue is inferred by indirect fluoroscopic, electrical and mapping cues. In a multicenter clinical study (TOCCATA), a novel irrigated radiofrequency ablation (RFA) catheter with an integrated force sensor was employed to ablate AF and AFL. We evaluated CF during catheter ablation as a function of both the ablation site and inter-operator variability.
Methods: Tacticath (Endosense Inc) is a saline-irrigated RFA catheter with 3 fiberoptic sensors able to detect the magnitude of CF (accuracy <1 g). The location and magnitude of CF was recorded for each RF application. AFL or AF pts were ablated (CTI block or electrical PV isolation) by 14 and 12 operators, respectively.
Results: The study cohort included 25 pts with typical AFL (age 62±11, 4F) and 34 pts with paroxysmal AF (age 60±8, 9F). For AFL, the CF during 246 ablations (9.8/pt) ranged from 0g to >80g. Per operator, the mean CF ranged from 7 to 37 g (p<.0001). Forces delivered with a long sheath were significantly higher (p <0.001), and the CF in non-successful AFL ablation cases (n=3) were lower (p=0.02). For AF, the CF during 958 ablations (28/pt) ranged from 1g to >100g. The CF by the operator with the sheath in the RA was lower than with the sheath in the LA, p<.0001. Regionally, the right-anterior-inferior LA region was the highest and the left-inferior-LAA ridge the lowest CF. The CF was <5 g in 12% of lesions; 5% were with intermittent contact.
Conclusions: A wide range of inter- and intra-operator CFs are seen during catheter ablation of AFL and AF. There are characteristic areas of low CF during AF ablation. The use of long sheaths greatly increases the observed CF.