Abstract 17016: Evaluation of Adequate Contact Force for Circumferential Pulmonary Vein Isolation
Optimal contact force (CF) for circumferential pulmonary vein (PV) isolation (CPVI) in patients with atrial fibrillation (AF) is unknown. To evaluate adequate CF for CPVI, we analyzed the relationship between CF and the number of residual conduction gaps (Ngap) after CPVI requiring touch-up ablation to complete CPVI.
In the consecutive 38 AF patients (29 men; mean age, 60 years; 11 with persistent AF) undergoing CPVI, 152 PVs were analyzed for CF and the number of gaps. CPVI was performed using a Thermcool Smarttouch catheter while setting the maximal CF at 20 g and power at 25-30W. The endpoint was the elimination of all PV potentials in the circular catheter and PV-to-LA block during PV pacing. CF map along CPVI line was created and was divided into 8 segments in both left and right PVs (4 segments in each of 4 PVs). Relationship between the mean CF (mCF) in each PV and Ngap were analyzed.
CPVI was achieved in all patients without any complications. mCF was <5 g in 20 PVs, of which Ngap was 2.2±1.2 and zero in only 2 PV (10%). mCF was between 5 and 9 g in 51 PVs, of which Ngap was 1.4±1.2 (p<0.05 vs <5 g) and zero in 15 PVs (29%, p<0.05 vs <5 g). mCF was between 10 and 14 g in 55 PVs, of which Ngap was 0.7±1.0 (p<0.01 vs 5-9 g) and zero in 37 PVs (67%, p <0.05 vs 5-9 g). mCF was greater than 15 g in 15 PVs, of which Ngap was 0.7±0.8 (p=NS vs 10-14 g) and zero in 7 PVs (47%, p=NS vs 10-14 g).
Thus, Ngap was significantly decreased as CF was increased. However, CF greater than 15 g was not associated with the further decrease in Ngap, suggesting that the optimal CF for CPVI is between 10 and 20 g.
- © 2013 by American Heart Association, Inc.